ANODYNE IMAGERY - AN ALTERNATIVE TO IV SEDATION IN INTERVENTIONAL RADIOLOGY

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.