Periprocedural rescue antiemetic administration during radiologic procedures performed under conscious sedation

This study aimed to determine the incidence and clinical predictors of periprocedural rescue antiemetic administration during radiologic procedures performed under conscious sedation.

We performed a retrospective review of adult patients who underwent radiologic procedures under conscious sedation with midazolam and/or fentanyl between May 6, 2018, and December 31, 2024. Rescue antiemetics was defined as the use of an antiemetic during the procedure or recovery period. A modified Apfel score (excluding need for postprocedural opioids) was calculated. Logistic regression was used to assess the association of clinical characteristics with the need for rescue antiemetics.

Among 21,343 unique patients, 990 (4.64%; 95% confidence interval [CI] 4.34-4.93) were administered a rescue antiemetic. Clinical factors associated with the need for rescue antiemetics included female sex (adjusted odds ratio [OR], 2.31; 95% CI, 1.99-2.67), history of postprocedural nausea and vomiting (OR, 1.99; 95% CI, 1.59-2.48), younger age (OR, 0.84 per decade of life; 95% CI, 0.81-0.88), procedural duration (OR, 1.78 per hour; 95% CI, 1.60-1.99), and fentanyl dose (OR, 1.12 per 25 mcg; 95% CI, 1.07-1.16). Risk increased with higher modified Apfel scores. Duration of recovery was longer among patients who were administered vs not administered a rescue antiemetic (median duration 116 [73, 165] vs 47 [27, 100] minutes, P < 0.001).

Rescue antiemetic administration during radiologic procedures with conscious sedation complicates <5% of cases. Risk factors for rescue antiemetics are similar to those for postprocedural nausea and vomiting following general anesthesia.