Ketamine/Midazolam versus Fentanyl/Midazolam Sedation for Interventional Radiology Procedures: A Prospective Registry

To assess whether sedation with ketamine/midazolam was more effective than fentanyl/midazolam at reducing periprocedural pain scores for interventional radiology (IR) procedures.

Data on preprocedural, intraprocedural, and postprocedural pain scores, procedure duration, and moderate or worse adverse events (AEs) were collected as part of a prospective quality improvement registry before and after the introduction of a ketamine/midazolam sedation program at a single academic center, including 292 procedures performed on adult patients from April 2024 to August 2024. All IR staff were surveyed before and after the introduction of ketamine regarding their observations on sedation, with 23 respondents at baseline survey and 22 at follow-up.

Compared with fentanyl/midazolam sedation, ketamine/midazolam sedation was associated with lower intraprocedural (P ≤ .001) and postprocedural (P ≤ .05) pain scores, without prolonging procedure duration (P = .436) or increasing AEs (P > .999). The effect on pain scores was observed for biopsy and drainage, but not for venous port procedures. Staff reported that ketamine/midazolam sedation provided adequate comfort more often than fentanyl/midazolam sedation (P ≤ .01), and at study conclusion, most (82%) reported that they would choose ketamine/midazolam sedation for themselves.

Compared with fentanyl/midazolam, ketamine/midazolam sedation was superior regarding reduction of patient discomfort and preference by IR staff, with no added procedural duration or AEs when administered in the absence of anesthesiology providers. Findings suggest further investigation into incorporating ketamine into routine use in IR programs.