INTRODUCTION

The performance of minimally invasive interventional radiology procedures has increased in a significant fashion over the past 20 years. The trend in modern medicine has definitely moved toward solving medical problems with minimally invasive techniques. This trend toward minimally invasive techniques has made it extremely important for the interventionalist to be able to provide adequate sedation and analgesia during interventional procedures. Providing effective and safe sedation and analgesia has become part of the standards of care for any interventional radiology practice.

Selected patients undergoing very simple procedures may not require any sedation or analgesia; however, most of the therapeutic procedures currently performed in interventional radiology suites require the patient to be under moderate sedation and analgesia, which is also known as “conscious sedation” or, more appropriately, “sedation and analgesia.”

The purpose of this chapter is to provide an overview of the most important components of sedation that an interventional radiologist should know about sedation and analgesia. The chapter will address the use of medications, mechanisms of action, doses, and antagonists, as well as the appropriate ways to monitor the patient.

DEFINITIONS

The terms sedation and analgesia refer to a fluctuant state of conscious depression induced by pharmacological agents (1). In 2002, the American Society of Anesthesiologists (ASA) published well-defined guidelines for sedation and analgesia by nonanesthesiologists. The document specifies the spectrum of sedation/analgesia and provides qualitative parameters for the classification of stages of sedation (Table 1).