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Sedation and Analgesia in Adult Patients: Evaluation of a Staged-Dose System Based on Body Weight for Use in Abdominal Interventional Radiology¹

¹ From the Departments of Radiology (S.J.S., S.M., J.R., G.T., D.G., J.A., S.S., G.W.S.) and Anaesthesia (N.B.), McMaster University Medical Centre, Hamilton, Ontario, Canada; and St Vincent’s University Hospital, Dublin, Ireland (D.E.M.). From the 1998 RSNA scientific assembly. Received November 29, 1998; revision requested January 14, 1999; final revision received February 3, 2000; accepted February 22. Address correspondence to D.E.M. (e-mail: d.malone@st-vincents.ie).

PURPOSE: To evaluate the safety and effectiveness of a systematic protocol for sedation and analgesia in interventional radiology.

MATERIALS AND METHODS: Ninety-one adult patients underwent 113 abdominal interventional procedures. Fentanyl citrate and midazolam hydrochloride were administered in one to five steps (A, B, C, D, E) until the patient was drowsy and tranquil at the effective loading dose (ELD). Doses per step were as follows: A, fentanyl 1 µg per kilogram of body weight; B, midazolam 0.010–0.035 mg/kg; C, repeat dose in A; D, repeat half the dose in B; and E, midazolam 1–2-mg boluses (maximum, 0.15 mg/kg).

RESULTS: The ELD was reached in no procedure after step A, in 70 after B, in 23 after C, and in 18 after D. Step E was needed in two procedures. The mean maximum pain score (scale of 0 to 10) was 3.4; pain scores in 85 (75%) procedures were 4 or less (discomforting). Severe pain occurred in seven (6%) procedures. Hypoxia (oxygen saturation < 90%) occurred in 11 (22%) procedures performed in patients breathing room air and four (6%) performed in those breathing supplemental oxygen (P = .04). All patients responded to supplemental oxygen.

CONCLUSION: This stepwise "ABCDE protocol" allows safe and effective sedation of patients. It is easy to use and may be useful in training radiology residents, staff, and nurses in the techniques of sedation and analgesia. Supplemental oxygen should be used routinely.

Index terms: Abdomen, interventional procedures • Anesthesia • Special Reports

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