Fundamental Procedural Radiology Peri-Procedural Tasks: Determining What Type Of Sedation/Anesthesia The Patient Will Require

OVERVIEW

While interventional radiology procedures are minimally invasive, they still often times will require some type of sedation/anesthetic to help keep patients comfortable. This is an important determination to make prior to the start of the procedure (and even in some cases prior to scheduling the procedure) because it can significantly change peri-procedural considerations/management.

While often times more involved forms of sedation are not required for IR procedures it is important to make sure this determination is made sooner rather then later because it will alter some aspects of peri-procedural workflow (image source).
WHAT OPTIONS ARE THERE TO PICK FROM?

It is useful to be aware of what types of sedation/anesthesia options exist so that you can make a more informed decision about which is most appropriate for the patient/procedure in question.

  • Local anesthesia (lidocaine) only: this option just refers to injecting local anesthetic in the region where the procedure will be performed. This will usually always be done (in conjunction with the other options listed below).
  • Pain medications only (often IV fentanyl): for those who need more pain control, but wish to remain completely conscious, IV pain medications can be given in addition to local anesthetic.
  • Conscious sedation (IV fentanyl and IV versed): a combination of these medications is typically used for what is called “conscious” or “mild” sedation. The versed is a sedative that works with the fentanyl to keep the patient more comfortable.
  • General anesthesia: this will be identical to the anesthesia used often in the operating room. The patient will be intubated and be put completely under.
WHY DO WE CARE? HOW DOES THIS CHANGE OUR PROCEDURAL CONSIDERATIONS?

It is important to appreciate that what type of sedation we choose has implications with regards to peri-procedure considerations. We must ultimately chose a sedation plan for our patients that is both safe and considerate of their comfort, however we should also be aware of the procedural  implications of each choice.

Local anesthesia (lidocaine only):

  • Pre-procedural diet: the administration of lidocaine on its own does not require the patient to be NPO.
  • Patient IV access: access is generally NOT needed, IV medications are administered.
  • Patient driving post procedure: the patient will be able to drive immediately after the procedure.
  • Anesthesia support: none needed.

Pain medications only (IV fentanyl):

  • Pre-procedural diet: the administration of only pain mediations on its own does not require the patient to be NPO.
  • Patient IV access: access is needed, IV medications are administered.
  • Patient driving post procedure: patients will need to wait for the pain medications to wear off before driving (generally 4-8 hours).
  • Anesthesia support: none needed.

Conscious sedation (IV fentanyl and IV versed):

  • Pre-procedural diet: the administration of versed will require patients to be NPO prior to the procedure.
  • Patient IV access: access is needed, IV medications are administered.
  • Patient driving post procedure: patients will generally not be able to drive themselves home if they receive versed that day. They will generally need to leave with another person who will drive and chaperone them.
  • Anesthesia support: none needed.

General anesthesia:

  • Pre-procedural diet: the administration of lidocaine on its own does not require the patient to be NPO.
  • Patient IV access: access is needed, IV medications are administered.
  • Patient driving post procedure: patients will generally not be able to drive themselves home if they receive versed that day. They will generally need to leave with another person who will drive and chaperone them.
  • Anesthesia support: will be required to be booked in ADVANCE. Anesthesia and radiology schedules will need to be coordinated.
WHEN IS JUST LOCAL ANESTHESIA APPROPRIATE?

For smaller cases that require minimal intervention, using only local anesthesia is often times very appropriate. The se include procedures such as: paracentesis, thoracentesis, and thyroid biopsy.

Related image
While using only lidocaine is not appropriate for all procedures, it does have its advantages when it is utilized (image source).

There are rarely universal rules, however if the intervention only involves superficial spaces and small caliber needles/equipment then using only local numbing medications (such as lidocaine) is often times in the best interest of the patient. 

The advantages of using only local anesthesia is that the patient will not need to be NPO for the procedure,

 

 

Page Updated: 08.07.2019