Radiologist-guided Analgosedation with Ketamine/Midazolam: A Feasible Strategy to Expand Percutaneous Tumor Ablation...

Area of Science:

• Oncology
• Radiology
• Anesthesiology

Background:

• Rising case numbers and limited anesthesia resources restrict capacity for percutaneous thermal tumor ablation.
• Radiologist-guided analgosedation presents a potential alternative to general anesthesia for selected ablation procedures.
• Limited scientific research exists on the feasibility of percutaneous thermal ablation under analgosedation.

Purpose of the Study:

• To evaluate the safety, technical success, and impact on procedural throughput of microwave (MWA) and radiofrequency ablation (RFA) under analgosedation.
• To assess the use of midazolam and S-ketamine for analgosedation in hepatic, renal, and osseous tumor ablations.
• To compare procedural volume and efficiency with general anesthesia.

Main Methods:

• Retrospective single-center study of 140 percutaneous tumor ablations in 115 patients.
• Procedures performed under radiologist-guided analgosedation with midazolam and S-ketamine (January 2022 - July 2024).
• Primary endpoint: sedation-related complications. Secondary endpoints: technical success, ablation complications, procedural volume changes.

Main Results:

• High technical success rate (98.3% completed as intended) with no major complications.
• One minor complication (CIRSE grade 1 subcapsular hepatic hematoma) and transient post-interventional vomiting in 3.5% of patients.
• Significant increase in procedural volume (2.1 to 6.3 ablations/month) and reduced mean in-room time (42 ± 34 min vs. 98 ± 42 min) compared to general anesthesia.

Conclusions:

• Radiologist-guided analgosedation with midazolam and S-ketamine is a feasible and safe approach for percutaneous thermal ablation of liver, kidney, and bone tumors.
• This method achieves high technical success without increasing complication rates and can significantly expand procedural capacity.
• Adequate training, structured workflows, and emergency preparedness are crucial for safe implementation.