Common procedures and strategies for anaesthesia in interventional radiology

Landrigan‐Ossar, Mary

doi:10.1097/aco.0000000000000208

Cited by 10 publications

(4 citation statements)

References 59 publications

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“…Over the past two decades, there has been a trend of increased utilization of MAC in IR [ 4 , 5 ] and other specialties. [ 6 ] This study shows that there are time-saving benefits in retaining nurse-administered MOSED in IR.…”

Section: Discussionmentioning

confidence: 99%

“…This is a result of IR physicians performing increasingly complex procedures on patients who are progressively sicker and have multiple coexisting health conditions, necessitating the attainment of deeper levels of sedation during these interventions. [ 4 , 5 ] For patients undergoing procedures under MAC, a physician anesthesiologist performs a pre-procedure assessment and is subsequently present in the procedure room or oversees a certified registered nurse anesthetist during the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology

Sotirchos,

Alexander,

Zhao

et al. 2024

JCIS

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Objectives: In recent years, there has been increased utilization of monitored anesthesia care (MAC) in interventional radiology (IR) departments. The purpose of this study was to compare pre-procedure bed, procedure room, and post-procedure bed times for IR procedures performed with either nurse-administered moderate sedation (MOSED) or MAC. Material and Methods: An institutional review board-approved single institution retrospective review of IR procedures between January 2010 and September 2022 was performed. Procedures performed with general anesthesia or local anesthetic only, missing time stamps, or where <50 cases were performed for both MAC and MOSED were excluded from the study. Pre-procedure bed, procedure room, post-procedure bed, and total IR encounter times were compared between MAC and MOSED using the t-test. The effect size was estimated using Cohen’s d statistic. Results: 97,480 cases spanning 69 procedure codes were examined. Mean time in pre-procedure bed was 27 min longer for MAC procedures (69 vs. 42 min, P < 0.001, d = 0.95). Mean procedure room time was 11 min shorter for MAC (60 vs. 71 min, P < 0.001, d = 0.48), and mean time in post-procedure bed was 10 min longer for MAC (102 vs. 92 min, P < 0.001, d = 0.22). Total IR encounter times were on average 27 min longer for MAC cases (231 vs. 204 min, P < 0.001, d = 0.41). Conclusion: MAC improves the utilization of IR procedure rooms, but at the cost of increased patient time in the pre- and post-procedure areas.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology

Sotirchos,

Alexander,

Zhao

et al. 2024

JCIS

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“…Sclerotherapy for vascular malformations requires at the very least deep sedation in the paediatric setting as increased pain and swelling related to the procedure are commonplace [5]. Among vascular malformations, venous malformations are the most common form with an incidence of 1–5 in 10,000 [6].…”

Section: Discussionmentioning

confidence: 99%

Successful postoperative analgesia with ilio‐inguinal nerve block following sclerotherapy for a labial venous malformation

Kim

Josephs

Tsui

2020

Anaesthesia Reports

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Though ilio-inguinal nerve block has been commonly utilised in male urologic surgery, a single injection ilioinguinal nerve block alone has not previously been reported for analgesia of the vulva. In this report, we describe the case of a 14-year-old girl undergoing sclerotherapy of a venous malformation affecting the labia majora and minora. After induction of anaesthesia, we performed an ultrasound-guided ilio-inguinal nerve block using a total volume of 15 ml of ropivacaine 0.2% with 1 lg.ml À1 dexmedetomidine which provided effective postoperative analgesia. Though the patient received intravenous analgesia intra-operatively and had an inpatient bed reserved in anticipation of severe postoperative pain, she required no further analgesia and was discharged home following 2 hours in the postoperative anaesthesia care unit. With the additional use of dexmedetomidine resulting in prolonged efficacy of the block, the patient reported effective postoperative relief for approximately 30 hours, solely using ibuprofen for pain relief. This case reminds clinicians that the ilioinguinal nerve block may provide benefit not only for male urologic surgery but also for procedures involving the external female genitalia, with extended analgesia with the use of dexmedetomidine.

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“…nterventional radiology (IR) procedures are becoming more complex with advancements in minimally invasive techniques, rise of comorbidities, and increasing use of moderate sedation performed at the direction of a nonanesthesiologist (1)(2)(3). Older patients and patients with complex medical conditions who are ineligible for or considered too high risk for surgical procedures are progressively referred to the IR suite.…”

mentioning

confidence: 99%

Impact of Respiratory Compromise in Inpatient Interventional Radiology Procedures with Moderate Sedation in the United States

Urman¹,

Moucharite²,

Flynn³

et al. 2019

Radiology

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Background: Despite increased use of moderate sedation in interventional radiology (IR), patient reactions to moderate sedation are difficult to predict. The rate, risk factors, and burden of respiratory compromise in patients who undergo IR procedures with moderate sedation in the United States are poorly understood. Purpose: To identify risk factors and quantify the clinical and economic burden of respiratory compromise in inpatient IR procedures in the United States. Materials and Methods: Primary inpatient IR procedures with moderate sedation conducted from October 1, 2012, to September 30, 2015, were analyzed by using a retrospective claims database. Exclusions included age younger than 18 years, use of anesthesia, pre-existing cardiac or respiratory arrest, and respiratory failure. Respiratory compromise was defined as use of naloxone or flumazenil, nonmechanical or cardiopulmonary resuscitation, or endotracheal intubation on the day of the IR procedure. Propensity score matching was performed to risk adjust patients for cost and outcomes analysis, including hospital and intensive care unit (ICU) length of stay, invasive mechanical ventilation, and death before hospital discharge. Results: This study analyzed 525 151 patients (mean age, 60 years 6 17 [standard deviation]; 278 576 women). Respiratory compromise occurred in 1.0% (5235 of 525 151) of patients, predicted by long-term opioid therapy or active substance abuse (odds ratio [OR], 2.7; P , .001), age 65 years or older (OR, 1.4; P , .001), and sleep apnea (OR, 1.3; P , .001). Risk-adjusted patients with respiratory compromise compared with patients without respiratory compromise had $6904 higher costs (P , .001), 1.1-day longer hospital length of stay (P , .001), and higher rates of ICU admission (69.7% [3125 of 5235] vs 25.5% [1333 of 5235], respectively; P , .001), invasive mechanical ventilation (33.6% [1758 of 5235] vs 1.6% [85 of 5235], respectively; P , .001), and death (27.1% [1421 of 5235] vs 3.2% [166 of 5235], respectively; P , .001). Conclusion: In the United States, respiratory compromise in interventional radiology procedures with moderate sedation contributes to worse clinical outcomes and higher costs. Respiratory compromise risk factors including long-term opioid therapy or active substance abuse, age 65 years or older, and sleep apnea should be preassessed and used to help guide intraprocedural monitoring to prevent respiratory compromise, improve patient outcomes, and reduce costs.

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Common procedures and strategies for anaesthesia in interventional radiology

Cited by 10 publications

References 59 publications

Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology

Comparison of periprocedural and procedure room times between moderate sedation and monitored anesthesia care in interventional radiology

Successful postoperative analgesia with ilio‐inguinal nerve block following sclerotherapy for a labial venous malformation

Impact of Respiratory Compromise in Inpatient Interventional Radiology Procedures with Moderate Sedation in the United States

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