Interventional Radiologist-Directed Sedation Versus General Anesthesia for Percutaneous Biliary Drainage: Effects on Procedural Efficiency and Hemodynamic Stability.

PURPOSE: To compare procedural efficiency, hemodynamic stability, analgesic outcomes, and adverse events between interventional radiologist-directed sedation and general anesthesia (GA) for primary percutaneous biliary drainage.

MATERIALS AND

METHODS

This institutional review board-approved retrospective study included consecutive adults undergoing primary biliary drainage between 2021 and 2026. Procedure duration and turnover intervals were derived from procedural imaging timestamps. Pain scores and opioid utilization were recorded for one day before and after procedures. Sedation-related adverse events within 6 h and 30-day complications were assessed. Procedures were analyzed as independent events.

RESULTS

Primary outcomes included procedure room turnover times and intraoperative hypotension. Eighty-seven procedures were performed in 75 patients (42 radiologist-directed; 45 GA). Thirty radiologist-directed cases included ketamine. Procedure duration was similar between groups (median 36.5 vs. 43.0 min; p = 0.218), but pre-procedure (median 66 vs. 110 min; p < 0.001) and post-procedure turnover (median 58 vs. 97.5 min; p < 0.001) were shorter for radiologist-directed sedation, representing a combined 84-min reduction. Intraoperative hypotension (nadir systolic blood pressure < 90 mm Hg) occurred in 5/42 (12%; 95% CI 2-22%) radiologist-directed cases versus 31/45 (69%; 95% CI 55-82%) GA cases (p < 0.001). There were no statistically significant differences in postoperative inpatient pain scores, opioid utilization, and 30-day complications and mortality. Findings were consistent in sensitivity analysis restricted to ketamine cases.

CONCLUSION

In this retrospective single-center cohort, radiologist-directed sedation for primary biliary drainage was associated with shorter procedure room turnover and fewer episodes of intraoperative hypotension compared with GA.