Clinical Outcome and Safety of Procedural Sedation and Analgesia Performed by Interventional Radiologists in Patients Undergoing Local Tumor Ablation of the Liver.

PURPOSE: To evaluate clinical outcome and safety of procedural conscious sedation and analgesia (PCSA) performed by interventional radiologists (IRs) for patients undergoing percutaneous high-dose-rate brachytherapy (HDR-BT) of the liver.

MATERIAL AND

METHODS

This large-scale, monocentric, retrospective study analyzed the safety-profile of PCSA using fentanyl and midazolam in patients undergoing HDR-BT for liver tumors. Medication was administered by trained IRs exclusively responsible for drug administration and cardiorespiratory monitoring. American Association of Anesthesiologists (ASA) status was recorded for all patients. Peri- and post-interventional complications directly or presumably related to PCSA, were assessed.

RESULTS

Between 08/2017 and 12/2023, 1062 minimally invasive tumor ablations were performed in 686 patients with: 29.4% hepatocellular carcinoma, 28.7% metastasized colorectal cancer, 6.4% cholangiocarcinoma, metastases from lung cancer (6.1%), pancreatic cancer (4.1%), neuroendocrine tumors (5.1%) and 15.8% other metastases. PCSA-related complications were low (14/1062 procedures, 1.3%). Peri-interventional arrhythmias occurred during 4 procedures (0.4%). One patient (0.09%) experienced severe hypoxemia requiring brief cardiopulmonary resuscitation with return of spontaneous circulation, intubation and ICU-admission. Multivariable regression showed no significant correlations of PCSA-related complications with age, sex, BMI, ASA, chronic obstructive pulmonary disease (COPD), liver cirrhosis or medication doses but a significant correlation of obstructive sleep apnea syndrome (OSAS). No peri- or post-procedural deaths occurred.

CONCLUSION

PCSA can safely be performed by adequately trained IRs with standardised protocols and support from anesthesiologists for emergencies or high-risk-patients. Careful patient selection, hemodynamic monitoring, structured PCSA documentation and immediate availability of anesthesiological support for severe AEs are essential to minimize risks. PCSA in OSAS should be managed by anesthesiologists.