title: Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study.
abstract: OBJECTIVE
  The aim of this study was to test the hypothesis that moderate procedural sedation can reduce the incidence of radial artery spasm.
  
  
  BACKGROUND
  Transradial access for left heart catheterization and percutaneous coronary intervention is increasingly used for emergent and elective procedures, in lieu of the femoral approach. However, increased rates of access site crossover have been reported, with radial artery spasm being a major contributor to this effect.
  
  
  METHODS
  Patients undergoing elective transradial percutaneous coronary intervention were prospectively randomized to receive fentanyl and midazolam during the procedure or no treatment (control subjects). The primary endpoint was angiographically confirmed radial artery spasm. Patient discomfort was quantified with a visual analogue scale.
  
  
  RESULTS
  Two thousand thirteen patients (age 64.5 ± 8.4 years) were randomized. Spasm occurred in 2.6% of the treatment group versus 8.3% of control subjects (p < 0.001; odds ratio [OR]: 0.29). The number needed to treat to avoid 1 case of spasm was 18 (95% confidence interval [CI]: 12.9 to 26.6). The access site crossover rate was 34% lower in the treatment group: 9.9% versus 15.0% (OR: 0.62; 95% CI: 0.48 to 0.82). Patient discomfort visual analogue scale score was 18.8 ± 12.5 in the treatment group versus 27.4 ± 17.4 in control subjects (p < 0.001). No significant differences were observed in the 30-day rate of death or repeat hospital stay for any cause: 4.6% versus 4.5% (OR: 1.02; 95% CI: 0.67 to 1.56).
  
  
  CONCLUSIONS
  Routine administration of relatively low doses of an opioid/benzodiazepine combination during transradial interventional procedures is associated with a substantial reduction in the rate of spasm, the need for access site crossover, and the procedure-related level of patient discomfort.
authors.affiliation: Cardiology Department and Cardiac Catheterization Laboratory, Athens General Hospital G. Gennimatas, Athens, Greece.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Raisakis
authors.forename: Georgios
authors.initials: G
authors.lastname: Hahalis
authors.forename: Andreas
authors.initials: A
authors.lastname: Kaoukis
authors.forename: Charalambos
authors.initials: C
authors.lastname: Kossyvakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Avramides
authors.forename: Loukas
authors.initials: L
authors.lastname: Pappas
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.forename: Vlasios
authors.initials: V
authors.lastname: Pyrgakis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D016292:Procedural Sedation; D017023:Coronary Angiography; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D006115:Greece / Q000453:epidemiology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015994:Incidence; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008874:Midazolam / Q000008:administration & dosage*; D008875:Middle Aged; D016017:Odds Ratio; D010146:Pain / Q000453:epidemiology / Q000517:prevention & control; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000187:drug effects*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl