Abstract 359: Unit-Specific Influences on Conscious Sedation Nursing Practices: Comparing Medication Utilization and Patient Outcomes

Background: Prior studies have assessed variation in radiation use and fluoroscopy times for patients undergoing coronary angiography (CA) and percutaneous coronary intervention (PCI); however, the extent that this varies by cath labs is unknown. Methods: We analyzed data from the VA National CART Program of patients undergoing CA and PCI between 2010 and 2011 (n=28,513). Radiation exposure was measured using fluoroscopy time. We fit a mixed effects linear regression using log fluoroscopy time as outcome, a random effect for site, and adjusted for procedural and patient characteristics. Empirical Best Linear Unbiased Predictors for sites were used to estimate adjusted site level medians. The intra-class correlation (ICC) for site random effect was calculated to estimate the proportion of variance explained by site adjusting for patient and procedural characteristics. Marginal residuals were aggregated to site and examined at quarterly intervals for 2 years to establish stability of site medians over time. Results: Overall site median fluoroscopy time was 6 minutes (IQR: 3.5, 10.2) for CA and 16.5 (IQR: 10.3,26.1) minutes for PCI. After adjusting for procedural and patient characteristics, site median fluoroscopy times ranged from 43% below to 57% above the median for CAs and 66% below to 75% above for PCIs (Figure). Sites in the top quartile of fluoroscopy time were above the overall median in 96% for CA and 99% for PCI of time periods assessed. Cath lab site accounted for a significant amount of variance in fluoroscopy times (11.9% for CA and 21.5% for PCI). Conclusion: There is significant variation in fluoroscopy times across VA cath labs for coronary angiographies and PCIs. Even after adjustment for patient and procedures factors, there remains significant variability at the cath lab level suggesting that there may be opportunities for quality improvement interventions to reduce fluoroscopy times and radiation exposure for patients undergoing these procedures.

Effectiveness of remifentanil & propofol infusion for procedural sedation in patients undergoing gastrointestinal endoscopic procedures: a systematic review protocol

The Nurse Radiographers’ Experience of Meeting with Patients During Interventional Radiology

Keywords: percutaneous coronary intervention; structural heart disease intervention; congential heart disease; adults; congenital heart disease; pediatrics

Anesthesia for Office-Based Surgery: Are We Paying Too High a Price for Access and Convenience?

Pharmacological agents for procedural sedation and analgesia in the emergency department and intensive care unit: a systematic review and network meta-analysis of randomised trials

Development of National Research and Clinical Agendas for Patient-Reported Outcomes in IR: Proceedings from a Multidisciplinary Consensus Panel

Laparoscopic Sterilization Under Local Anesthesia with Conscious Sedation Versus General Anesthesia: Systematic Review of the Literature

Based on NCRP (2005), skyshine radiation generally occurs in radiotherapy facilities, the cause of which is that some radiation facilities are designed with minimal shielding on the linear accelerator (Linac) ceiling. As time goes by, Skyshine radiation monitoring is not only focused on radiotherapy facilities, but radiodiagnostic facilities also need to be monitored, especially interventional radiology, which uses real-time X-ray radiation at certain times. Regarding this matter, it is necessary to check whether the walls of the existing angiography room or cath lab are protected from skyshine radiation. This study aims to determine whether the Angiography/Cathlab room at Mitra Keluarga Kemayoran Hospital does not produce skyshine radiation. The method for measuring skyshine radiation exposure uses a survey meter at a distance of 30 cm and 2 meters 3 times from the outer wall of the Angiography/Cathlab room on the north, south, and west sides of the gantry; then the gantry is positioned at 0 degree. The research results show that radiation exposure is 0.14 µSv/hour at a distance of 30 cm. Skyshine radiation was detected at a distance of 2 meters with an exposure value of 0.32 µSv/hour on the west side of the gantry and 0.39 µSv/hour on the north side of the gantry, this occurred due to the radiation barrier wall (Pb ) not complete until the ceiling is only 2 meters high from the floor. The conclusion is that the walls of the Angiography/Cathlab room at Mitra Keluarga Kemayoran Hospital have exposure to skyshine radiation at a distance of 2 meters measured from the outer walls of the Angiography/Cathlab room on the west and north sides of the gantry of 0.32 µSv/hour and 0.39 µSv/hour. Keywords: angiography/cath lab, radiation, X-ray, skyshine, interventional radiology.

Purpose The purpose of this study was to evaluate the feasibility and safety for CT-guided High Dose Rate brachytherapy under conscious sedation with analgesia performed by interventional radiologists in patients with liver malignancies. Material and Methods This prospective, observational, and IRB-approved single-center study (EA/122/23) aimed to evaluate patient experiences and outcomes related to the procedure. A total of 74 patients with malignant liver tumors were included in the final analysis. Data were collected using structured questionnaires, with pain assessed via numeric rating scales (NRS). The study also analyzed the following parameters: 1. Age; 2. Sex; 3. Number of lesions, catheters, and pre-treatments; 4. Tumor size (complete tumor volume, CTV); 5. Tumor location and 6. Complications. Results Pain was measured (0: no pain; to 10: maximum pain) 1. at catheter placement; 2. at the time of radiation (catheter removal); 3. After the radiation on the ward. At catheter placement, 74.5% rated the pain as low (0–2), 19.0% as moderate (3–6), and 6.5% as severe (7–10). At the radiation and afterwards, pain levels were rated as low in 84.0% and 79.5%, as moderate in 11.0% and 16.0% and as severe in 5.5% and 4.0%, respectively. At the time of irradiation, women reported increased pain ( p < 0.001), and the number of lesions were associated with higher pain levels ( p < 0.05). Mild to moderate complications were observed in 23.0% including pain and fever. No major complications were observed. Conclusion In conclusion, CT-guided HDR brachytherapy under conscious sedation with analgesia performed by interventional radiologists in patients with liver tumors is safe and feasible and can be integrated into the clinical routine.

04:03 PM Abstract No. 40 The clinical and economic burden of respiratory compromise in inpatient interventional radiology procedures with procedural sedation

Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge (1). The American Society for Gastrointestinal Endoscopy (ASGE), the American College of Gastroenterology (ACG), and the American Gastroenterological Association (AGA) have continually promoted the ideal that all patients have access to high-quality GI endoscopy services. A high-quality endoscopy is an examination in which patients receive an indicated procedure, correct and relevant diagnoses are recognized or excluded, any therapy provided is appropriate, and all steps that minimize risk have been taken.

Report by the American Society of Anesthesiologists Task Force on Neuraxial Opioids* PRACTICE guidelines are systematically developed recommendations that assist the practitioner and patient in making decisions about health care.These recommendations may be adopted, modified, or rejected according to clinical needs and constraints, and are not intended to replace local institutional policies.In addition, practice guidelines developed by the American Society of Anesthesiologists (ASA) are not intended as standards or absolute requirements, and their use cannot guarantee any specific outcome.Practice guidelines are subject to revision as warranted by the evolution of medical knowledge, technology, and practice.They provide basic recommendations that are supported by a synthesis and analysis of the current literature, expert and practitioner opinion, open forum commentary, and clinical feasibility data.This document updates the "Practice Guidelines for the Prevention, Detection and Management of Respiratory Depression Associated with Neuraxial Opioid Administration" adopted by ASA in 2007, and includes new survey data and recommendations pertaining to monitoring for respiratory depression.

Objective: To evaluate the therapeutic efficacy of interventional radiology (IR) combined with delayed aortic repair in patients with acute type A aortic dissection (ATAAD) with concurrent mesenteric malperfusion syndrome (MeMPS), and explore the risk factors for visceral organ failure and death after IR. Methods: A total of 693 patients with ATAAD admitted to Xijing Hospital from January 2018 to March 2022 were retrospectively analyzed. The therapeutic outcomes of IR combined with delayed aortic repair in patients with MeMPS were observed. Logistic regression was used to analyze the risk factors for mortality due to visceral organ failure after IR. Results: Among the 693 patients, 656 patients (507 males and 149 females) aged [M(Q1, Q3)] 52 (44, 58) years did not have any organ malperfusion syndrome, while all 37 (31 males and six females) aged 50 (46, 55) years with MeMPS underwent IR followed by delayed aortic repair after clinical improvement. The median symptom onset time in MeMPS patients was 0.3 (0.2, 0.4) d, and the overall in-hospital mortality was 43.2% (16/37). Some patients also had multiple organ malperfusion syndrome (kidney: 10 cases; lower extremity: two cases). Among the 24 MeMPS patients (64.9%) whose condition improved after IR and who subsequently underwent aortic repair, the in-hospital mortality rate showed no significant difference compared to patients without MeMPS [12.5% (3/24) vs 8.2% (54/656), P=0.714]. Similarly, there were no significant differences in the 1-, 3-, and 5-year survival rates between the two groups (79.2%, 54.4%, 54.4% vs 81.2%, 78.9%, 77.7%, respectively; P=0.300). After IR, death due to organ failure was the main reason preventing aortic repair in MeMPS patients (organ failure: 10 cases; aortic rupture: three cases). Compared with survivors after IR, patients who died of organ failure had higher age, creatinine, D-dimer, and fibrinogen degradation products (FDP), and a smaller true lumen diameter of the abdominal aorta at the diaphragm level (all P<0.05). Multivariate logistic regression analysis identified that the true lumen diameter of the abdominal aorta at the diaphragm level (OR=0.72, 95%CI: 0.52-0.99), FDP (OR=1.03, 95%CI: 1.01-1.06), and D-dimer (OR=1.07, 95%CI: 1.01-1.13) were risk factors for death due to visceral organ failure. Conclusions: For ATAAD patients with concurrent MeMPS, salvage IR can serve as a bridging therapy prior to aortic repair. The true lumen diameter of the abdominal aorta at the diaphragm level, D-dimer, and FDP are risk factors for death due to visceral organ failure.

present in 97.5% 30 min after the procedure. Patient satisfaction was also very good with 99.8% willing to repeat the same procedure. These findings serve to further confirm the strong impression that propofol is safe for use as a conscious sedation agent for endoscopy in the hands of appropriately trained endoscopists and endoscopy nurses. There are several studies over the last few years (involving over 200,000 patients) examining propofol administration for endoscopy by gastroenterologists and specially trained endoscopy nurses [3–9] . A recent metaanalysis found no increase in the risk of cardio-pulmonary complications with the use of propofol sedation for endoscopy, as compared to the use of traditional sedative agents. There was not a single patient in these studies who required intubation or died. Nonetheless, despite the plethora of safety data relating to the use of propofol by endoscopists and endoscopy nurses, there are still concerns within the community. A key factor is appropriate patient selection as there is a more recent study which reported a very small number of deaths in patients who received propofol for conscious sedation, most of whom were undergoing more prolonged procedures and/or were higher risk ASA (American Society of Anesthesiologists) class [10] . Of note, none of the patients in this recent series underwent colonoscopy or standard routine gastroscopy. The current study by Horiuchi et al. [2] focuses on lowdose propofol in diagnostic EGD, and irrefutably confirms the safety of such a practice. Many of us are familiar with the situation in which a patient is somewhat combative during an endoscopic procedure, but sleeps like a baby for what seems an age afterwards. Despite undoubted advances in this area, it is glaringly obvious that we have significant room for improvement in how we sedate patients. So, what about propofol? Propofol is an intravenous anesthetic agent often used with other agents for delivery of general anesthesia, but increasingly used in lower doses to induce conscious sedation. Hardly a month goes by without some study supporting the use of propofol by non-anesthesiologists for conscious sedation. Propofol has some undoubted advantages over benzodiazepines and opiates [1] . A particular advantage that is much cited by advocates of using propofol for conscious sedation is that it has a very short half-life, between 2 and 4 min, so there is a much shorter time to recovery from the drug than with midazolam, which has a 30-minute half-life. Rapid induction of sedation and subsequent patient recovery would accelerate patient turnover, allowing more procedures to be done per session. Would this be achieved at the expense of safety? It would appear not. In this issue of Digestion , Horiuchi et al. [2] from Japan prospectively look at the safety of nurse-administered low-dose propofol (30–80 mg total) for diagnostic esophagogastroduodenoscopy (EGD). An impressive 12,031 patients were studied. Only 1.1% of subjects developed transient oxygen desaturation, and full recovery was Published online: December 18, 2008