Clinical Outcome and Safety of Procedural Sedation and Analgesia Performed by Interventional Radiologists in Patients...

To evaluate clinical outcome and safety of procedural conscious sedation and analgesia (PCSA) performed by interventional radiologists (IRs) for patients undergoing percutaneous high-dose-rate brachytherapy (HDR-BT) of the liver.

This large-scale, monocentric, retrospective study analyzed the safety-profile of PCSA using fentanyl and midazolam in patients undergoing HDR-BT for liver tumors. Medication was administered by trained IRs exclusively responsible for drug administration and cardiorespiratory monitoring. American Association of Anesthesiologists (ASA) status was recorded for all patients. Peri- and post-interventional complications directly or presumably related to PCSA, were assessed.

Between 08/2017 and 12/2023, 1062 minimally invasive tumor ablations were performed in 686 patients with: 29.4% hepatocellular carcinoma, 28.7% metastasized colorectal cancer, 6.4% cholangiocarcinoma, metastases from lung cancer (6.1%), pancreatic cancer (4.1%), neuroendocrine tumors (5.1%) and 15.8% other metastases. PCSA-related complications were low (14/1062 procedures, 1.3%). Peri-interventional arrhythmias occurred during 4 procedures (0.4%). One patient (0.09%) experienced severe hypoxemia requiring brief cardiopulmonary resuscitation with return of spontaneous circulation, intubation and ICU-admission. Multivariable regression showed no significant correlations of PCSA-related complications with age, sex, BMI, ASA, chronic obstructive pulmonary disease (COPD), liver cirrhosis or medication doses but a significant correlation of obstructive sleep apnea syndrome (OSAS). No peri- or post-procedural deaths occurred.

PCSA can safely be performed by adequately trained IRs with standardised protocols and support from anesthesiologists for emergencies or high-risk-patients. Careful patient selection, hemodynamic monitoring, structured PCSA documentation and immediate availability of anesthesiological support for severe AEs are essential to minimize risks. PCSA in OSAS should be managed by anesthesiologists.