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BackTable / VI / Podcast / Episode #381

Anesthesia vs. Moderate Sedation: A Spectrum of Care

with Dr. Vishal Kumar

In this episode, interventional radiologists Dr. Aaron Fritts, Dr. Vishal Kumar, and Dr. Chris Beck discuss types of sedation for IR procedures.

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Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar on the BackTable VI Podcast)
Ep 381 Anesthesia vs. Moderate Sedation: A Spectrum of Care with Dr. Vishal Kumar
00:00 / 01:04

BackTable, LLC (Producer). (2023, November 3). Ep. 381 – Anesthesia vs. Moderate Sedation: A Spectrum of Care [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Vishal Kumar discusses Anesthesia vs. Moderate Sedation: A Spectrum of Care on the BackTable 381 Podcast

Dr. Vishal Kumar

Dr. Vishal Kumar is an interventional radiologist with UCSF in California.

Dr. Christopher Beck discusses Anesthesia vs. Moderate Sedation: A Spectrum of Care on the BackTable 381 Podcast

Dr. Christopher Beck

Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Dr. Aaron Fritts discusses Anesthesia vs. Moderate Sedation: A Spectrum of Care on the BackTable 381 Podcast

Dr. Aaron Fritts

Dr. Aaron Fritts is a Co-Founder of BackTable and a practicing interventional radiologist in Dallas, Texas.

Show Notes

We start the discussion off by dividing the spectrum of patient sedation into three tiers: local anesthesia, moderate sedation with fentanyl and Versed, and deep sedation which encompasses anything beyond fentanyl and Versed. The conversation revolves around the fluidity of this spectrum, underscoring the ease with which patients can transition between these sedation levels, thereby adding layers of complexity to the decision-making process. Chris emphasizes the significance of embracing trauma-informed care, highlighting the potential for IR procedures to be maximally traumatic despite their minimally invasive nature. The doctors emphasize the importance of establishing comprehensive pre-procedural patient education to align expectations about pain management.

Procedures that automatically trigger the requirement for an anesthesia team include procedures such as TIPS, tumor ablations, as well as declot procedures more recently. Decisions regarding anesthesia for these procedures are additionally influenced by factors such as the patient's condition, history of methadone exposure, the preference of the IR providers, and the comfort level of nursing staff.

Vishal highlights the game-changing concept of having an anesthesia team present for real-time monitoring and the administration of nerve blocks during IR procedures. This collaboration is especially helpful for complex interventions. Vishal advocates for prioritizing patient safety over logistical considerations. He firmly contends IRs should be empowered to decide the level of anesthesia care since they have the most experience with the specific procedures and are best suited to recognize anesthesia needs.

The conversation delves into the American Society of Anesthesiologists (ASA) scoring system, which categorizes patients based on their health status from ASA 1 (healthy) to ASA 6 (brain death). While IR procedures usually involve ASA 3 or ASA 4 patients, today’s discussion uncovers the tendency among clinicians to underestimate a patient's ASA classification while overestimating their pain tolerance. The discussion raises critical questions about whether the IR community has grown complacent with moderate sedation in procedures and whether alternative approaches are warranted.

Resources

American Society of Anesthesiologists Classification (ASA) Classification:
https://www.ncbi.nlm.nih.gov/books/NBK441940/

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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