[Sedation analgesia in interventional radiology].
OBJECTIVE
Development of a save and effective protocol for analgosedation of patients undergoing painful interventional procedures.


METHODS
In a prospective trial a consecutive series of 72 adult patients underwent analgosedation during painful interventions. A radiologist performed the analgosedation, the patients received a combination of a shortly effective piperidine derivative (Alfentanil [Rapifen(R)]; 7.5 - 15 microgram/kg body weight) and Benzodiazepine (midazolam [Dormicum(R)]; 20 microgram/kg body weight). After pre-procedure oxygenation patients were continuously monitored. Pain and discomfort were scored using an established visual-analog pain score (0 - 10). A control group (n = 24) had received midazolam, pentazocine or fentanyl according to the study protocol.


RESULTS
All procedures could be carried out by an interventional radiologist and a nurse and/or technologist only. In 69/72 cases adequate analgosedation could be achieved. Injection of alfentanil was titrated, with a rapid onset and short acting effect of the analgesia. Patients reported an average pain score of 2.6 vs. 4.5 in the control group. Over 55 % experienced no or mild pain (score 0 - 3), in the control group only 8 % reached this level.


CONCLUSIONS
A combination of shortly effective alfentanil and midazolam allows interventional radiologists to perform major procedures alone under effective analgosedation. This medication scheme is superior to the medication upon demand.
Linsenmaier
U
U
Institut für Klinische Radiologie, Klinikum der Universität München, Innenstadt, Germany.
Wagner
P
P
Pfeifer
K J
KJ
Reiser
M
M
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage / Q000627:therapeutic use*; D015760:Alfentanil / Q000008:administration & dosage / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010146:Pain / Q000175:diagnosis / Q000517:prevention & control*; D010147:Pain Measurement; D010423:Pentazocine / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D015642:Radiology, Interventional
D000759:Adjuvants, Anesthesia; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D015760:Alfentanil; D008874:Midazolam; D010423:Pentazocine