Ketamine safe for interventional radiology procedures, new randomized trial shows
Ketamine is a safe sedation alternative for interventional radiology procedures, according to the results of a new randomized trial, shared on Tuesday.
Opioid-benzo combinations remain the standard regimen in image-guided procedures, despite recognized risk of respiratory depression and hypoxemia. However, ketamine has emerged as a potential substitute, demonstrating favorable analgesic and safety profiles in the ED and endoscopic procedures, experts write in RSNA’s Radiology.
Researchers recently aimed to assess the performance of ketamine in IR care, conducting a randomized clinical trial at a single center between 2025 and 2026. They found promising results, with ketamine providing improved analgesia, better patient-reported experience and fewer hypoxemic events than fentanyl.
“As procedural care evolves toward prioritizing patient-centered outcomes and minimizing opioid exposure, continued reliance on opioid-benzodiazepine sedation deserves re-examination,” lead author Amy R. Deipolyi, MD, PhD, an IR specialist and associate professor with the West Virginia University School of Medicine, and colleagues wrote Sept. 8.
The randomized trial recruited adults undergoing image-guided lung or bone biopsy or abscess drainage procedures. Subjects were randomized to receive either fentanyl/midazolam or ketamine/midazolam, which was administered by interventional radiologists. Procedures were performed using ultrasound, computed tomography, CT fluoroscopy or combined CT-US guidance. Intraprocedural pain was measured on a 10-point scale, while patients’ experience was assessed via a questionnaire.
Among 264 randomized procedures (132 per group) in 260 participants, ketamine resulted in lower maximum intraprocedural pain than fentanyl (at an average difference of -1.4 points). Pain scores greater than 4 occurred less frequently with ketamine (2.3% vs. 17%). Oxygen desaturation below 90% also occurred less frequently with ketamine (2.3% vs. 9.8%). Meanwhile, patient-reported recall was lower and overall procedural comfort was higher with ketamine.
In a corresponding editorial, experts charged that these results warrant attention from radiology leaders. The study demonstrated a near-elimination of moderate to severe procedural pain in the ketamine arm, with the results not coming at the cost of respiratory safety. However, “ketamine is not a panacea,” the editorialists cautioned, with it also potentially posing side effects such as dysphoria, delirium and visual hallucinations.
“Ultimately, evolving how we sedate our patients is not merely a matter of periprocedural comfort; it is about securing the operational flexibility necessary to push the boundaries of advanced image-guided therapeutics,” wrote Clifford R. Weiss, MD, and Lauren S. Park, MD, both with the Division of Interventional Radiology at Johns Hopkins Hospital, Baltimore. “It is time for interventional radiology to thoughtfully and rigorously consider embracing ketamine.”
Read more, including potential study limitations, in the Radiological Society of North America’s flagship journal.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.