Ev. Lang et D. Hamilton, ANODYNE IMAGERY - AN ALTERNATIVE TO IV SEDATION IN INTERVENTIONAL RADIOLOGY, American journal of roentgenology, 162(5), 1994, pp. 1221-1226
OBJECTIVE, Pain and anxiety are to be expected in patients undergoing
interventional procedures, and they are usually treated by IV consciou
s sedation. Insufficient treatment of pain and anxiety can cause cardi
ovascular strain and restlessness, which may jeopardize the success of
the procedure. On the other hand, pharmacologic oversedation can prov
oke respiratory and cardiovascular depression, thereby increasing the
procedural risks and delaying the patient's recovery. We therefore eva
luated a nonpharmacologic method, which we call anodyne imagery (anody
ne: able to soothe or relieve pain; soothing the feelings; relaxing),
as an alternative to the use of drugs in interventional radiology. SUB
JECTS AND METHODS. Anodyne imagery technique consists of conditioned r
elaxation, induction of a trance state, and guided processing of the p
atient's internal imagery. An intrapatient comparison of drug use was
made in five patients who had equivalent procedures with and without a
nodyne imagery and an intergroup comparison was made between a group o
f 16 other patients undergoing anodyne imagery and a group of 16 contr
ol patients matched for factors affecting use of drugs and recruited f
rom 100 interventional cases analyzed for patterns of drug use. For st
atistical analysis, drug unit scores (weighting: 1 mg of midazolam = 1
unit and 50 mu g of fentanyl = 1 unit) were compared within patients
by paired t-test and between groups of patients by analysis of varianc
e in two-sided tests, with p less than .05 considered to be significan
t. RESULTS. The 100 patients who did not have anodyne imagery received
0-6 mg of midazolam (median, 1.4 mg), 0-500 mu g of fentanyl (median,
80 mu g), and 0.5-9 drug units (median, 2.5). Drug administration was
insignificantly affected by the physician conducting the procedure, t
he type of procedure, or the patient's age, but significantly increase
d with longer table times. Ten of the 21 patients undergoing anodyne i
magery associated fear-provoking images with their interventional proc
edure that were generally intense, vivid, and dramatic. Intrapatient c
omparison showed significantly lower median drug use with anodyne imag
ery than without (0.1 vs 5.3 drug units, p = .01). Intergroup comparis
on also yielded significantly lower median drug use during procedures
with anodyne imagery than without (0.2 vs 2.6 drug units, p = .0001).
CONCLUSION. Patients having interventional radiologic procedures frequ
ently experience intense and frightening imagery related to the proced
ure. Our initial experience with anodyne imagery suggests that this al
ternative method of analgesia can mitigate patients' anxiety and fears
and reduce the amount of drugs used during interventional radiologic
procedures, and thereby has the potential to improve procedural safety
and increase the speed of recovery.