Introduction
As vascular interventional radiology (VIR) procedures become more complex, many patients are requiring increased levels of sedation during these procedures. In a certified registered nurse (RN) anesthetist resource limited practice, RNs have had to adapt their practices to effectively meet these comfort demands. This article describes a practice pilot and retrospective study of RN-administered intravenous remimazolam for moderate sedation during VIR procedures. The specific aims of the study were to describe the detailed demographics of patients undergoing minimal vascular radiology procedures, doses of sedatives administered, impact of remimazolam in recovery, and discuss remimazolam-related complications.
Methods
This study reviewed charts of 273 adult patients from the VIR practice within one institution who received remimazolam during procedural sedation between March 20, 2023, and September 1, 2023. Most cases were unique; however, there were 10 cases in which each patient underwent more than one VIR procedure. Data were analyzed using the Kruskal-Wallis rank test, chi-square test, and linear regression.
Results
Of the 273 trial patients who received RN-administered remimazolam, two patients (0.7%) who had also received fentanyl experienced adverse hypotension or bradycardia events requiring some sort of intervention from anesthesia personnel. One patient did not complete a radiology intervention due to vein occlusions resulting in the case being canceled. Finally, there was one allergic-like reaction (IgE mediated) and no intraprocedural mortality noted with the use of RN-administered remimazolam in the VIR procedural area. Postrecovery time decreased from 67 min on average to 42.4 min on average (1.58%).
Conclusions
This research and other research to follow will contribute to the knowledge of how remimazolam can be a helpful and safe sedative amnestic used in varying procedural settings. Although statistical significance was not achieved, our team concluded that the process yielded positive outcomes for patients in terms of the safe and effective administration of remimazolam by nursing staff. In conclusion, we have identified how remimazolam can be leveraged by RNs outside of the operating room and intensive care unit settings to optimize sedation and recovery times.
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