Safety of Ketamine Sedation for Interventional Radiology Procedures: Experience in 900 Consecutive Patients

Area of Science:

• Anesthesiology
• Interventional Radiology
• Sedation Management

Background:

• Sedation is crucial for interventional radiology (IR) procedures.
• Anesthesiologist presence is not always feasible for IR sedation.
• Alternative sedation regimens are needed.

Purpose of the Study:

• To evaluate the safety of ketamine/midazolam sedation for IR procedures.
• To assess sedation administered by IR physicians without anesthesiology support.
• To determine the incidence of adverse events with this sedation protocol.

Main Methods:

• Retrospective study of 900 adult IR procedures with ketamine/midazolam.
• Data collected on demographics, procedure types, medication doses, and adverse events.
• Sedation-related adverse events defined by specific criteria (reversal agents, rapid response, allergic reaction, hypotension, respiratory events).

Main Results:

• Ketamine/midazolam sedation was used for biopsies, drainages, venous access, and angiography.
• Median doses: Midazolam 2 mg, Ketamine 40 mg.
• Low incidence of desaturation (<90% in 0.7%) and no intubations or vasopressor use.
• Four sedation-related adverse events (0.4%) reported, including hypotension, combativeness, fall, and transient desaturation.

Conclusions:

• Ketamine/midazolam sedation is safe for diverse IR procedures.
• Rare adverse respiratory and hemodynamic events observed.
• Supports ketamine/midazolam as a safe alternative to fentanyl/midazolam in IR.