Medicine and Radiology - Research Publications

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Start date: 2015 × End date: 2018 × Author: Koukounaras, James ×

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    Randomized and controlled study comparing patient controlled and radiologist controlled intra-procedural conscious sedation, using midazolam and fentanyl, for patients undergoing insertion of a central venous line.
    Clements, W ; Sneddon, D ; Kavnoudias, H ; Joseph, T ; Goh, GS ; Koukounaras, J ; Snow, T (Wiley, 2018-12)
    INTRODUCTION: Interventional Radiology procedures can provoke anxiety and may be painful. Current practice, Radiologist Controlled Sedation (RCS), involves titrating aliquots of midazolam and fentanyl to patient response but underdosing and overdosing may occur. This study tests a new method of titrating sedation/analgesia during the procedure, Patient Controlled Sedation (PCS), in which a combination of fentanyl and midazolam are administered using a patient-controlled analgesia pump. This allows the patient to self-control their sedation/analgesia during the procedure. METHODS: We performed a randomised control trial comparing the effects of pain, sedation, amnesia and overall patient satisfaction between PCS and RCS, by enrolling forty patients undergoing insertion of a tunnelled central line. RESULTS: Our results showed that PCS was safe, with no adverse events. PCS was effective in providing sedation, amnesia and overall pain relief comparable to RCS. There was no significant difference in dose given to patients using PCS or RCS. There was a tendency for patients in the PCS group to begin sedation later than those in the RCS group, but both were equally sedated during the procedure. We show that patients in the PCS group were very satisfied with the procedure. CONCLUSIONS: We show that PCS is non-inferior to RCS in terms of dosage given and degree of sedation. To the authors' knowledge, this is the first study to show intra-procedural PCS in an Interventional Radiology setting using midazolam and fentanyl as a randomised comparative trial. It has wide applicability in a procedural setting for very low cost and with minimal additional training required.
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    Prolonged balloon tamponade in the initial management of inferior vena cava injury following complicated filter retrieval, without the need for surgery
    Lee, JTL ; Goh, GS ; Joseph, T ; Koukounaras, J ; Phan, T ; Clements, W (WILEY, 2018-12)
    Advanced techniques have been described to remove embedded inferior vena cava (IVC) filters including the loop snare and modified loop snare (Hangman) techniques. Retrieval of embedded filters have been associated with higher rates of complications including IVC injury and stenosis. We report two challenging embedded retrievals complicated by IVC injury and haemorrhage. Haemostasis was successfully achieved with prolonged balloon tamponade, suggesting that injury to the IVC during filter retrieval may not need urgent surgery. However, both patients received short-term complications related to caval thrombosis and patients in this cohort should be closely observed after retrieval. These cases support rigorous attention to filter indication and follow-up.