Con: moderate sedation is safely performed by nonanesthesiologists during percutaneous vascular interventions.

p NTRAVENOUS MEDICATIONS providing both amnesia and relief of pain have been available since the 1930s.1 nfortunately, little was known of the hemodynamic or respiatory consequences when thiopental was universally adminisered to sailors injured during the attack on Pearl Harbor. eferences to the practice led to this agent being called the ideal method of euthanasia in war surgery.”2 Fortunately, uch has changed since this early application. Administration of anesthesia is no longer limited to the perating room. As more minimally invasive procedures have een developed, the need for adequate pain relief and conscious edation have expanded to include physician offices, ambulaory care facilities, cardiac catheterization laboratories, endosopy suites, and even intensive care units in which prolonged eriods of sedation may be required for the severely injured. ore recently, many vascular surgical procedures are now eing performed endovascularly, and the interventional radiolgy suite is now a frequent site of prolonged periods of sedaion during complicated or lengthy procedures. The level of sedation achieved during these procedures in hese various locations has been defined by the American ociety of Anesthesiologists (ASA) based on the patient’s esponses. Minimal sedation is a drug-induced state during hich a patient responds normally to verbal commands. Cogitive function and coordination may be impaired, but ventilaory and cardiovascular functions are usually not affected. oderate sedation (previously referred to as conscious sedaion) is another drug-induced state during which the patient esponds to verbal commands but may require light tactile timulation prior to responding. A patent airway and cardioascular function are maintained without assistance.3 Accurate records of the number of procedures being perormed with this type of anesthesia are difficult to obtain. It was stimated in 1999 that more than 65% of surgical procedures ere performed as outpatient procedures.4 How many of these rocedures used minimal or moderate sedation versus general nesthesia is also not known. How many procedures were erformed within a hospital setting using minimal or moderate edation is currently not reported on a national level. A recent eview of quality assurance data within the author’s own instiution documented more than 29,000 patients receiving modrate sedation outside of the operating room in the last 4 years, ith more patients receiving moderate sedation each year (Fig ).5 Approximately 25% of these patients receive procedures in he cardiac catheterization laboratory and in the interventional adiology suite during percutaneous interventions. Most published data regarding the methods for administraion of sedation outside of the operating room have been ccumulated from voluntary responses to surveys by intervenional radiologists. Nearly all surveys documented some utiliation of conscious sedation during interventions. Methods of roviding sedation differed widely depending on institutional ractice. In a survey of Belgian radiologists, the majority of iagnostic arteriograms were performed with local anesthesia nly. Many percutaneous interventions were also performed m