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SIR 2026

Scientific Session

General IR

Session: General IR 1

127 - Ketamine Procedural Sedation in Interventional Radiology Without Anesthesiology: Experience from 900 Consecutive Cases

Monday, April 13, 2026
4:12 PM - 4:21 PM ET
Purpose: Procedural sedation in interventional radiology (IR) often relies on opioids and benzodiazepines, which may provide inadequate depth and carry cardiopulmonary risks. Ketamine offers deeper sedation without respiratory depression, but has not been widely adopted in IR. This study evaluates the safety of ketamine/midazolam sedation administered by IR physicians without anesthesiology presence in a large patient cohort.

Materials and Methods: All consecutive procedures performed on adult patients using intravenous ketamine/midazolam administered by IRs with no anesthesiology staff present were collected at a single institution from 7/24 to 1/25. Data is presented descriptively, with mean±standard deviation and (ranges) unless otherwise specified.

Results: Of 900 procedures (475 outpatient, 425 inpatient) performed in 785 patients (398 women, 387 men; 65±14 [18—96] years old), there were 8 cryoablations, 41 arteriograms/embolizations, 360 biopsies, 113 venous access cases, 346 drainage interventions, 19 pain interventions, and 13 venography/other cases. Of 900 cases, 79 (9%) entailed multiple procedures (e.g., port and biopsy). Among the 785 patients, 110 (14%) had sleep apnea and 102 (13%) had opiate dependence. Median dose of midazolam was 2 (range: 0.5—6) mg and ketamine was 40 (20—260) mg. Intravenous diphenhydramine was given in 17 (2%) to augment sedation; antiemetics were given in 104 (12%) due to nausea. Mean lowest oxygen saturation was 96 (83—100)%, with 380 (42%) cases managed on room air, 503 (56%) with nasal cannula, and 17 (2%) with simple or other types of masks. No patient required an oral or nasal airway or intubation. Lowest and highest mean systolic blood pressure was 122 (63—194) and 144 (93—243) mmHg. There were 4 (0.4%) sedation-related adverse events: flumazenil was administered in 1 (0.1%) due to hypotension; midazolam caused combativeness regardless of ketamine in 1; 1 patient fell from the table; 1 had desaturation prone that resolved when turned supine.

Conclusion: Ketamine/midazolam sedation was safely administered by IRs without anesthesiology presence, with a very low rate of adverse events far lower than those reported for opiate-based regimens. Compared with traditional fentanyl/midazolam sedation, ketamine/midazolam may improve patient safety and expand access to advanced IR procedures by reducing reliance on anesthesiology providers.