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

To evaluate the safety of ketamine/midazolam sedation for interventional radiology (IR) procedures administered by IR physicians without anesthesiology personnel present.

This single-center retrospective study, approved by the institutional review board (IRB) with waiver of consent, included all 900 consecutive IR procedures performed in adults with intravenous ketamine/midazolam sedation (July 2024 to January 2025). Demographic data, procedure type, medication doses, and adverse events were extracted from the electronic medical record (Cerner Millennium; Oracle Health, Kansas City, Missouri). All adverse events within 30 days were identified. Sedation-related adverse events were defined as administration of reversal agents, activation of a rapid response or code team, allergic reaction, hypotension requiring vasopressors, or respiratory events (intubation or placement of an advanced airway) within 6 hours of the procedure.

Procedures included biopsies (40%), drainages (38%), venous access (15%), angiography/embolization (5%), and others (2%). Median midazolam and ketamine doses were 2 mg (range, 0.5-6 mg) and 40 mg (range, 20-260 mg), respectively. Mean lowest oxygen saturation was 96% (range, 83%-100%); desaturation <90% occurred in 6 cases (0.7%). No patient required intubation, advanced airway placement, or vasopressor support. Four sedation-related adverse events (0.4%) occurred: hypotension treated with flumazenil, combativeness, patient fall, and transient desaturation while prone. Thirty-three nonsedation-related adverse events (3.7%) occurred within 30 days.

Ketamine/midazolam sedation was safely performed across a broad range of IR procedures. Adverse respiratory and hemodynamic events were rare, supporting ketamine/midazolam as a safe alternative to fentanyl/midazolam sedation in IR practice.