Available online 14 June 2025, 101037

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To perform procedures in the interventional radiology suite, patient comfort and tolerance must be ensured through appropriate anesthesia and analgesia. Various levels of anesthesia can be utilized to safely accomplish a procedure from local anesthesia and mild sedation to general anesthesia. Depending on patient and procedural factors, different anesthetic plans may be beneficial. Patient factors such as chronic pain, hemodynamic stability, and complex medical problems will likely benefit from anesthesiologist involvement in the procedure. Procedural factors such as specific positioning requirements, following instructions, or invasiveness of the procedure may dictate what level of anesthesia is required, as well. Various anesthetic agents are used for amnesia, anesthesia, analgesia, and muscle relaxation. Understanding patients’ needs and procedural requirements will aid a clinician in performing safe and effective interventional procedures and maintain safety – from preoperative evaluation and monitoring during the procedure to discharging from the recovery room.

Section snippetsLevels of Sedation

The American Society of Anesthesiology defines the levels of sedation as ranging from minimal sedation to general anesthesia (Table 1). These are defined by their effects on responsiveness, airway control (meaning the ability to maintain an open conduit from mouth/nose/atmosphere to the lungs), spontaneous breathing, and cardiovascular function.1 In lighter forms of sedation, a patient is responsive, has a patent, unaffected airway, breathes on their own, and has minimal change in their

Sedation

Several different medications can be used for procedural sedation (Table 2). The main medications used as sedatives today are propofol, dexmedetomidine, midazolam, ketamine, and etomidate.14 Propofol, midazolam, and etomidate are GABA agonists, dexmedetomidine is an alpha-2 agonist, and ketamine is an NMDA antagonist. All of these medications provide anesthesia, amnesia, and anxiolysis. Depending on the dosage, each medication can bring a patient to any level of sedation. Dexmedetomidine and

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