Conscious sedation for interventional neuroradiology: a comparison of midazolam and propofol infusion

Abstract

The aim of this study was to compare two conscious sedation techniques, midazolam (M) and propofol (P), for interventional neuroradiology by assessment of the incidence of complications and satisfaction scores. Methods" Forty patients were randomized to receive 0.75 pg-kg -~ fentanyl and a M or P bolus followed by an infusion; (M 15/Jg.k~ t + 0.5 Aug'kg-~'min-'; P 0.5 mg'kE-' + 25/Ig'kg -I rain-'), The incidences of complications and untoward events requiring intervention were documented. These included respiratory depression, excessive pain, inappropriate movements and the inability to examine the patient. TI~ satisfaction of the anaesthetic technique from the perspective of both the neuroradiolc~st and the patient was scored. ][~b~ull~: The incidence and types of complications were not different between the two groups. Pain occurred in 12 patients (6M, 6P), inappropriate movements in 17 (7M, lOP) and respiratory changes in I0 patients (2M, 8P). Conclusions, Both techniques were satisfa~.'-tory and the incidence of complications was similar for both groups.Objectis Cette (~tude visait t~ comparer deux m&hodes de s~dation consciente, le midazolam (M) et le propofol (P) pour les interventions neuroradiologiques en ~valuant l'incidence des complications et le de~m~ de satisfaction. M~l:hod~ : Quarante patients ont 6t~ r~partis al~atoirement pour recevoir fentanyI 0,75/Jg'kg-' et un bolus de P ou de M suivi par une perfusion : (M 15 ilJg-kg -I + 0,5 ~g'kg -Imin-I; P 0,5 mg'k~ ~ + 25 pg'kg -I min-I). L'incidence des complications et des effets ind&irables r~cessitant une intervention a ~t~ enregi~, La d~pres-sion respiratoire, la douleur exa~r~ae, les mouvements inappropri& et I'incapacit~ de subir rexamen ~taient consid&vas comme ind~irables. Un score &luivalent au degr~ de satisfaction i~ I'C~ard de la technique anesth~ique ~tait attribu~ en tenant compte du point de rue de I'anesth&iste et de celui du radiologiste, P,~sultal~ 9 I'incidence et le type de complication ne diff&aient pas entre les deux groupes. La douleur a ~t~ rapportc~e par 12 patients (61'4, 6P), des mouvements inappropri~ chez 17 patients (7M, I 0P) et des aJt&ations de la respiration chez 10 patients (2M, 8P). C, oncl~ion : Les deux techniques ont ~t~ satisfaisantes et I'incidence des complications ~atait la m~me darts les deux groupes.

Anesthesia for cerebral aneurysms: a comparison between interventional neuroradiology and surgery

“…Both neurolept/conscious sedation and general anesthesia have been described. [8][9][10][11]14 During conscious sedation, the awake patient serves as an effective overall monitor of neurological status. Conscious sedation may also be more suitable for patients with systemic medical problems.…”

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…The choice of anesthetic technique varies depending on the institution, with the most common techniques being conscious sedation and general anesthesia. [202][203][204] There have been no studies comparing these 2 techniques. One of the main goals of the anesthetic technique is keeping the patient motionless to optimize the quality of the images used to perform the endovascular procedure; hence, general anesthesia with endotracheal intubation is often preferred for these procedures.…”

Republished: Society for Neuroscience in Anesthesiology and Critical Care Expert Consensus Statement: Anesthetic Management of Endovascular Treatment for Acute Ischemic Stroke*

“…In a randomized controlled trial of sedation for neurointerventional procedures (not including AIS) a 25% incidence of respiratory complications (snoring, airway obstruction, SpO2<90% or respiratory rate <8/min) was reported despite administration of supplemental oxygen. 31 Hyperoxia has been suggested as a neuroprotective strategy to salvage acutely ischemic brain tissue and to extend the time window for the administration of thrombolytic drugs. 32 Cerebral blood volume and blood flow within ischemic regions have been shown to improve with high-flow oxygen therapy 33 and the regional cerebral vasoconstrictor responsiveness to 100% oxygen inhalation may be lost or paradoxically reversed in patients with acute hemispheric infarction.…”