Ketamine/Midazolam versus Fentanyl/Midazolam Procedural Sedation for Interventional Radiology: A Prospective Registry.

Abstract

Purpose: The study assessed whether sedation with ketamine/midazolam was more effective than fentanyl/midazolam at reducing peri-procedure pain scores for interventional radiology (IR) procedures.

Materials and methods: Pre-, intra-, and post-procedure pain scores, procedure duration, and moderate or worse adverse events were collected as part of a prospective quality improvement registry before and after the introduction of a ketamine/midazolam sedation program at a single academic center, including 292 procedures performed on adult patients from 4/2024 to 8/2024. All IR staff were surveyed before and after the introduction of ketamine regarding their observations on sedation, with 23 respondents at baseline survey and 22 at follow-up.

Results: Compared to fentanyl/midazolam sedation, ketamine/midazolam sedation was associated with lower intra- (P≤0.0001) and post-procedure (P≤0.05) pain scores, without prolonging procedure duration (P=0.4362) or increasing adverse events (P>0.999). The effect on pain scores was observed for biopsy and drainage, but not venous port procedures. Staff reported that ketamine/midazolam sedation provided adequate comfort more often than fentanyl/midazolam sedation (P≤0.01), and at study conclusion, most (82%) reported that they would choose ketamine/midazolam sedation for themselves.

Conclusion: Compared to fentanyl/midazolam, ketamine/midazolam sedation is superior regarding reduction of patient discomfort and preference by IR staff, with no added procedural duration or adverse events when administered in the absence of anesthesiology providers. Findings suggest further investigation into incorporating ketamine into routine use in IR programs.