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Sedation for neuroradiology revisited: comparison of three techniques for cerebral angiography

Published online by Cambridge University Press:  11 July 2005

M. A. Bewlay  and
A. S. Laurence
M. A. Bewlay
Affiliation:
Department of Anaesthetics, Royal Preston Hospital, Preston, Lancs, UK
A. S. Laurence
Affiliation:
Department of Anaesthetics, Royal Preston Hospital, Preston, Lancs, UK
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Extract

Summary

Background and objective: Previous work in our department, prior to the advent of digital subtraction angiography, showed that anaesthetist-administered sedation for cerebral angiography using propofol infusion–bolus fentanyl resulted in significantly more patients with early recall than a bolus fentanyl and midazolam technique. Our present study reassessed, 10 yr after our original study, the effectiveness of sedation for neuroradiological digital subtraction cerebral angiography, using three techniques currently in use in the department.

Methods: A total of 88 adult patients were sedated for neuroradiological angiograms by one of three anaesthetist-administered regimens: propofol–alfentanil infusion; boluses of fentanyl with a propofol infusion and boluses of fentanyl and midazolam. The latter two regimens had been used in our previous sedation study. Patients were assessed for time to orientation at the completion of the procedure, and followed up the next day to determine their last memory before sedation, first memory after the angiogram and any recall of the procedure itself.

Results: All three techniques were found to give satisfactory sedation and showed minimal difference in the time to orientation at the end of the procedure (3.7, 4.3 and 5.1 min), any awareness of the procedure itself (20% of patients overall) and numbers of patients having early recall; that is, recall of still being in the radiology department before return to the ward (22/29, 16/29 and 20/30).

Conclusions: Our results show that since the introduction of digital subtraction angiography we may have a different end-point of sedation compared to our original study, as well as a shorter angiogram time. Satisfactory anaesthetist-administered sedation can be provided for cerebral angiography by either infusion or incremental techniques. We feel that the success and safety of a sedation technique depends considerably on the skill and experience of the administrator such that these sedation techniques are only suitable for safe use by an anaesthetist.

Keywords

ANAESTHESIA AND ANALGESIA, conscious sedationANAESTHETICS, INTRAVENOUS, midazolamDIAGNOSTIC IMAGING, radiography, neuroradiography, cerebral angiographySEDATIVES, NON-BARBITURATE, propofol
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 726 - 730
Copyright
© 2003 European Society of Anaesthesiology

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References

Luginbuhl M, Remonda L. Interventional neuroradiology. Recent developments and anaesthesiologic aspects. Minerva Anesthesiol 1999; 65: 445–454.Google Scholar
Allen MWB, Laurence AS, Gunawardena WJ. A comparison of two sedation techniques of neuroradiology. Eur J Anaesthesiol 1989; 6: 379–384.Google Scholar
Sedation and Anaesthesia in Radiology; Report of a Joint Working Party. London, UK: Royal College of Anaesthetists and Royal College of Radiologists, 1992.
Lind LJ, Mushlin PS. Sedation, analgesia and anesthesia for radiologic procedures. Cardiovasc Intervent Radiol 1987; 10: 247–253.Google Scholar
Manninen PH, Gignac EM, Gelb AW, Lownie SP. Anesthesia for intervention radiology. J Clin Anesth 1995; 7: 448–452.Google Scholar
Report of the Joint Working Party on Anaesthesia in Ophthalmic Surgery. London, UK: Royal College of Anaesthetists, College of Ophthalmologists, 1993.
Recommendations for Standards of Monitoring During Anaesthesia. London, UK: Association of Anaesthetists of Great Britain and Ireland, 1998.
Manninen PH, Chan ASH, Papworth D. Conscious sedation for interventional neuroradiology: a comparison of midazolam and propofol infusion. Can J Anaesth 1997; 44: 26–30.Google Scholar
Vinik HR, Bradley EL, Kissin I. Triple anesthetic combination: propofol–midazolam–alfentanil. Anesth Analg 1994; 78: 354–358.Google Scholar