Sedation, Analgesia, and Local Anesthesia: A Review for General and Interventional Radiologists

Abstract

Radiologists, like other physicians, need to know how to use sedatives, analgesics, and local anesthetics; however, their exposure to patients requiring discomfort control is limited, not just during residency but also in postgraduate practice. The purpose of this article is to provide a reference guide for radiologists who need pertinent and ready information on discomfort control. The authors discuss policies and standards that the Joint Commission has established for sedation providers; also discussed are the clinical pharmacology and dosage recommendations for the sedative, analgesic, anesthetic, and reversal agents that radiologists are most likely to use. Monitored anesthesia care and patient-controlled analgesia pumps, and in what circumstances they may be appropriate, are discussed. Anesthesia consultations are not uncommon when a nonanesthesiologist needs either of these services. Stiff chest syndrome, serotonin release syndrome, and systemic toxicity due to local anesthesia, all life-threatening conditions that sedation and analgesia providers may encounter, are discussed. The causes of these conditions and their necessary treatments are included in the discussion, along with cases in which a nonanesthesiologist may need an anesthesia consultation. It is important to understand that the control of pain and anxiety are not mutually exclusive but can occur either separately or together; when an agent that controls anxiety and an agent that controls pain are given together, the overall effect is synergistic. It is also important to understand the concept of multimodal analgesia; this is the use of opioids and nonopioids together to take full advantage of the analgesic effects of each component while minimizing potential side effects. Radiologists are fully capable of providing effective and safe pain control on their own and with the assistance of an anesthesiologist.

Significance of debriefing methods in simulation-based sedation training courses for medical safety improvement in Japan

“…Second, sedation may expedite procedures that are not particularly uncomfortable, but that require patients to remain still in children and uncooperative adults. However, sedation sometimes result in cardiac or respiratory depression, which should be rapidly detected and appropriately managed in order to minimize the risks of adverse events (Moran et al 2013). Furthermore, inadequate sedation may induce unnecessary patient discomfort or injury, if associated with a lack of cooperation or adverse physiologic and psychological responses to stress.…”

Consensus conference on TIPS management: Techniques, indications, contraindications

“…Moreover TIPS positioning can be an uncomfortable and prolonged procedure requiring analgesics and sedatives administration, which could facilitate the transition to (GA) with or without intention, and could precipitate adverse physiological responses in particularly frail patients [45].…”

“…The anaesthetist, depending on the type, will define the frequency of monitoring and its invasiveness and amount of medication administered, the length of the procedure, and the general condition of the patient. Particular attention should be given to monitoring oxygenation, ventilation, circulation, level of consciousness and temperature [45,49]. • Severe liver failure (Child-Pugh > 11, serum bilirubin > 5 mg/dl, MELD > 18) (1a) [50].…”

Randomized and controlled study comparing patient controlled and radiologist controlled intra‐procedural conscious sedation, using midazolam and fentanyl, for patients undergoing insertion of a central venous line

“…Diagnostic and therapeutic procedures performed in Interventional Radiology (IR) can provoke anxiety and may be painful . Mild sedation and analgesia are administered by the Interventional Radiologist to calm patient anxiety, reduce unwanted movements and alleviate patient discomfort …”