Sedation and analgesia in adult patients: Evaluation of a staged-dose system based on body weight for use in abdominal interventional radiology

PURPOSE: To evaluate the safety and effectiveness of a systematic protocol for sedation and analgesia in interventional radiology. MATERIALS AND METHODS: Ninety-one adult patients underwent 113 abdominal in terventional procedures. Fentanyl citrate and midazolam hydrochloride were administered in one to five steps (A, B, C, D, E) until the patient was dro wsy and tranquil at the effective loading dose (ELD). Doses per step were a s follows: A, fentanyl 1 mu g per kilogram of body weight; B, midazolam 0.0 10-0.035 mg/kg; C, repeat dose in A; D, repeat half the dose in B; and E, m idazolam 1-2-mg boluses (maximum, 0.15 mg/kg). RESULTS: The ELD was reached in no procedure after step A, in 70 after B, i n 23 after C, and in 18 after D. Step E was needed in two procedures. The m ean maximum pain score (scale of 0 to 10) was 3.4; pain scores in 85 (75%) procedures were 4 or less (discomforting). Severe pain occurred in seven (6 %) procedures. Hypoxia (oxygen saturation < 90%) occurred in 11 (22%) proce dures performed in patients breathing room air and four (6%) performed in t hose breathing supplemental oxygen (P = .04). All patients responded to sup plemental oxygen. CONCLUSION: This stepwise "ABCDE protocol" allows safe and effective sedati on of patients. It is easy to use and may be useful in training radiology r esidents, staff, and nurses in the techniques of sedation and analgesia. Su pplemental oxygen should be used routinely.