Administration of conscious sedation by a neuroradiology team during percutaneous vertebroplasty and spinal biopsy procedures

Abstract

Introduction

Percutaneous vertebroplasty, i.e. the consolidation of a vertebral body with polymethylmethacrylate, is a safe and effective image-guided technique increasingly used as a treatment option for different pathologic conditions, mainly vertebral body fractures secondary to osteoporosis, hemangiomas and metastasis. The procedure, although minimally invasive, could be painful and is better tolerated if a conscious sedation regimen is added to local anesthesia. An anesthesiologist usually performs the sedo/analgesia, but frequently, he is not available in our angiography unit, so we have begun to perform the sedo/analgesia ourselves following an analogous situation that physicians of the Digestive Endoscopic Unit of our institution experienced some years ago.

Methods

Using the guidelines developed by Italian Society of Digestive Endoscopy, Italian Society of Anesthesia, Analgesia, Reanimation and Intensive Therapy and National Association of Endoscopy Operators and Technicians as a starting point, we then adapted their protocol to our vertebroplasty requirements, after an adequate training period carried out by our anesthesiologist staff.

Results

The results have been very satisfactory, greatly appreciated by patients for good pain control; we have never registered any adverse effects nor have we had any particular problems in controlling sedation or monitoring procedures.

Conclusion

In our experience, we have observed that conscious sedation can be safely administered by neuroradiologists during spinal procedures, provided that some basic rules are respected regarding patient selection and monitoring, personnel training and angiography equipment.