title: Sedation and analgesia in adult patients: evaluation of a staged-dose system based on body weight for use in abdominal interventional radiology.
abstract: OBJECTIVE
  To evaluate the safety and effectiveness of a systematic protocol for sedation and analgesia in interventional radiology.
  
  
  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 microg 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology, McMaster University Medical Centre, Hamilton, Ontario, Canada. d.malone@st-vincents.ie
authors.forename: S J
authors.initials: SJ
authors.lastname: Skehan
authors.forename: D E
authors.initials: DE
authors.lastname: Malone
authors.forename: N
authors.initials: N
authors.lastname: Buckley
authors.forename: S
authors.initials: S
authors.lastname: Matsumoto
authors.forename: J
authors.initials: J
authors.lastname: Rawlinson
authors.forename: G
authors.initials: G
authors.lastname: Ting
authors.forename: D
authors.initials: D
authors.lastname: Graham
authors.forename: J
authors.initials: J
authors.lastname: Alexander
authors.forename: S
authors.initials: S
authors.lastname: Somers
authors.forename: G W
authors.initials: GW
authors.lastname: Stevenson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000698:Analgesia; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D001835:Body Weight; D016292:Procedural Sedation; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D011860:Radiography, Abdominal; D015642:Radiology, Interventional
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D010100:Oxygen; D005283:Fentanyl