Ketamine a safe sedation alternative in the interventional radiology suite
Ketamine is a safe sedation alternative in the interventional radiology suite, according to new research published Friday.
As IR procedure volumes continue to climb, coupled with anesthesiology provider shortages, there is growing interest in achieving “deeper, more reliable sedation.” Researchers recently explored the use of ketamine/midazolam—a powerful dissociative anesthetic—as an alternative to opioids and other options, without the presence of an anesthesiology provider.
Among 900 consecutive procedures, ketamine was delivered safely without such support, experts write in the Journal of Vascular and Interventional Radiology. What’s more, adverse respiratory events were “extremely” rare, with no patients requiring intubation and zero serious complications relating to the heart and lungs.
“This is a major advancement in procedural sedation, since opioid-induced respiratory depression is associated with increased costs and lengths of stays for patients,” corresponding author Amy R. Deipolyi, MD, PhD, an academic interventional radiologist and associate professor with West Virginia University, and colleagues wrote Dec. 19. “Overall, findings confirm the relative absence of cardiopulmonary depression with ketamine/midazolam compared with fentanyl/midazolam sedation, affirming its critical safety advantage over traditional regimens,” they added later.
Researchers conducted the study at a single center in the back half of 2025. It included all 900 consecutive IR procedures performed on adults with intravenous ketamine sedation. The ability for interventional specialists to administer ketamine sedation required several steps in the institution, the authors noted. Hospital policy defined any such use of the drug as “deep sedation” and outlined steps for nonanesthesia providers to obtain privileges, along with specific hospital locations where it could be performed. IR docs met with the hospital sedation committee to propose and enact changes. Along with requiring advanced cardiovascular and basic life support certification, IRs performed an insertion of an oral or nasal airway observed by an anesthesiologist. Plus, they needed to perform three cases of deep sedation observed by another credentialed provider.
Procedures performed included biopsies (40%), drainages (38%), venous access (15%), angiography/embolization (5%) and others (2%). Median midazolam and ketamine doses were about 2 mg and 40 mg, respectively. The average lowest oxygen saturation was about 96%, with desaturation at less than 90% occurring in only six cases (0.7%). No patients required inserting a breathing tube into their windpipe, nor advanced airway placement or vasopressor support (used to treat low blood pressure during surgery).
Only four sedation-related adverse events (0.4%) occurred during the six-month study period. These included hypotension treated with flumazenil, combativeness, a patient fall, and transient desaturation while prone. In about 3.7% of cases, or 33 instances, non-sedation-related adverse events occurred within 30 days, including five deaths (0.6%) unrelated to the procedure. The most common adverse events were pneumothorax requiring chest tube placement after lung biopsy (6.3%), tube dislodgment after cholecystostomy placement (25%) and nephrostomy exchange
(5.3%), and external biloma requiring drainage after biliary drainage (6.7%).
“One important lesson from the experience reported here is that because ketamine sedation provides deeper levels of sedation than fentanyl regimens, patients are less aware of the position of their extremities and bodies,” the authors noted. “In one case where a patient was not well-restrained, the patient fell from the procedure table while sedated. Special care is required to secure patients, with unsecured extremities particularly vulnerable to injury.”
You can read much more in the official journal of the Society of Interventional Radiology. Dr. Deipolyi and colleagues also published another study about ketamine in IR care via the Journal of Radiology Nursing on Dec. 18. The piece explores how to develop a multidisciplinary ketamine sedation program in interventional radiology, including tips for implementation, expected outcomes, and lessons learned.
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.