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Medtronic / Clinical Solutions / Procedural Sedation Outside the Operating Room / Interventional Radiology

Better Procedures. More Advanced Sedations.

More patients, more procedures, more sedation decision.

From 2010 to 2014, the number of interventional radiology (IR) procedures requiring sedation outside the OR nearly tripled.([FOOTNOTE=Nagrebetsky A, Gabriel RA, Dutton RP, Urman RD. Growth of Nonoperating Room Anesthesia Care in the United States: A Contemporary Trends Analysis. Anesthesia & Analgesia. 2017;124(4):1261-1267.],[ANCHOR=],[LINK=])

New types of IR procedures are offering patients minimally invasive alternatives to surgery.([FOOTNOTE=Broomfield S, Bruce I, Birzgalis A, Herwadkar A. The expanding role of interventional radiology in head and neck surgery. J R Soc Med. 2009;102:228–34.],[ANCHOR=],[LINK=]) This may impact how clinicians sedate patients.

Sedation in the IR Suite

Care in Dosing

Physiologic changes resulting from obesity can affect drug distribution and elimination. Dosing an obese patient based on total body weight may result in an overdose, while using their ideal body weight may result in a sub-therapeutic dose. With others, clinicians rely on their own experience.3

Sedating for longer procedures

In performing a procedure with deep sedation for ~4.5 hours, clinicians:

  • Continuously titrated sedative agents
  • Devised a unique mix of sedatives
  • Employed continuous monitoring
  • Assigned team member dedicated to monitoring5
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Balancing sedation and alertness

To maintain conscious sedation, clinicians:                      

  • Carefully titrate medications
  • Consider non-prone positions for patients
  • Continuously assess pain6

Patient Choice Leads to Satisfaction

Chosen sedation levels:

  • No sedation: 27%
  • Minimal sedation: 36%
  • Moderate sedation: 37%7
  • Reported satisfaction: 100%7

Addressing the Comorbidities Challenge

Patients who are not qualified for surgery in the OR may instead undergo IR procedures and receive sedation.([FOOTNOTE=Browning RF, Parrish S, Sarkar S, et al. Bronchoscopic interventions for severe COPD. J Thorac Dis 2014;6:S407-15],[ANCHOR=],[LINK=]) These may include patients with serious conditions such as COPD or advanced cancer.8,([FOOTNOTE=Grendelmeier P, Tamm M, Jahn K et al. Flexible bronchoscopy with moderate sedation in COPD: a case–control study. Int J Chron Obstruct Pulmon Dis. 2017; 12: 177–187],[ANCHOR=],[LINK=]),([FOOTNOTE=Palussiere J, Henriques C, Mauriac L, et al. Radiofrequency ablation as a substitute for surgery in elderly patients with nonresected breast cancer: pilot study with long-term outcomes. Radiology. 2012;264:597–605],[ANCHOR=],[LINK=])

As more procedures become available to patients with comorbidities, sedation decisions pose an ongoing challenge to clinicians. The ARIN endorses capnography monitoring during procedural sedation.([FOOTNOTE=Green, Karen L. et al. Association for Radiologic & Imaging Nursing Position Statement: Capnography. Journal of Radiology Nursing. 2016 35:1:63 – 64],[ANCHOR=],[LINK=])

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Unique Patients. Unique Sedations.

Capnography Monitoring Can Help.

Resources

Access valuable resources to help educate sedation providers outside the OR on providing safe and adequate
sedation.

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