Sedation and patient monitoring in vascular and interventional radiology

Abstract

A postal survey of British and Irish interventional radiologists was carried out in 1991 in order to assess current practice with respect to sedation and monitoring of patients during angiography and interventional procedures. The response rate was 65%. 49% of patients are fasted prior to angiography and 68% prior to interventional procedures. Radiologists participate in obtaining consent in 60% of cases. Patients are often (50%) sedated for angiography and usually (62-94% depending on the procedure) sedated for interventional procedures. Nurses are present for most procedures, but are given the task of monitoring the patient's vital signs in only 49% of cases. Anaesthetists are present for less than 10% of interventional procedures. Pulse oximetry is used routinely in 20% of departments, and automatic blood pressure monitors in 16%. 28% of radiologists never administer oxygen to patients under sedation, whereas 4% always do. 43% of departments have a staffed recovery area. Most vascular/interventional suites are stocked with emergency drugs and 80% with a defibrillator. 28% of departments report at least one death during or shortly after a procedure during the last 10 years. 18% of interventional radiologists have taken a refresher course in cardiopulmonary resuscitation in the past year. These findings indicate a wide variation in practice and a need to standardize practice at a uniform high level.

Anesthesia and Sedation Practices Among Neurointerventionalists during Acute Ischemic Stroke Endovascular Therapy

“…While a small literature exists regarding standard sedation practices for elective interventional radiology procedures of various types (McDermott et al, 1993; Mueller et al, 1997), emergent acute stroke therapy is distinct. Single center case series of non-emergent procedures showed no apparent increase in complication rates in neurointerventional procedures performed in awake patients (Qureshi et al, 2001; Abou-Chebl et al, 2006).…”

Analgosedierung in der interventionellen Radiologie

“…Die groûe Mehrzahl der Eingriffe unter Sedation wird von den minimalinvasiv tätigen ¾rzten selbst durchgeführt. Nach Literaturangaben ist nur in etwa 10 % der Fälle bei radiologisch-interventionellen Eingriffen ein Anästhesist vor Ort, in den meisten Fällen allerdings eine hierfür ausgebildete Pflegekraft [3]. Zielsetzung der Analgosedierung ist es, minimalinvasive Eingriffe möglichst schmerz-und angstfrei für den Patienten zu gestalten, wobei im Gegensatz zur Allgemeinnarkose die Schutzreflexe und die Kooperationsfähigkeit erhalten bleiben.…”

“…In der Vergangenheit reichte dies von Lachgas als Maskennarkose [7,8], bis hin zur intravenösen Gabe von Nalbuphin (Nubain ), Pentazocin (Fortral ), Morphin (u. a. MST , MSR ) [3,9], Diazepam (u. a. Valium , Tranquase ) [10] oder Tramadol (Tramal ) [11]. In neuerer Zeit wurden besonders Midazolam (Dormicum ) oder Propofol (u. a. Disoprivan , Klimofol ) als Einzelmedikation eingesetzt [12 ± 14].…”

Patients' experiences of cardiology procedures using minimal conscious sedation

“…For example, surveys undertaken in Europe, 1 the United States, 2 and the United Kingdom 3 have identified a variety of conscious sedation protocols involving the use of an assortment of benzodiazepine, analgesic, and antihistamine medications that aim to keep patients in an awake/alert state of consciousness during radiologic diagnostic or interventional procedures. Moreover, when comparing the degree and use of sedation in diagnostic and interventional vascular and visceral procedures, Haslam et al 1 found that, in general, interventional visceral procedures were performed using deeper levels of sedation.…”