@article{3157049,
    title = "Moderate Procedural Sedation and Opioid Analgesia During Transradial
Coronary Interventions to Prevent Spasm A Prospective Randomized Study",
    author = "Deftereos, Spyridon and Giannopoulos, Georgios and Raisakis, and Konstantinos and Hahalis, Georgios and Kaoukis, Andreas and Kossyvakis, and Charalambos and Avramides, Dimitrios and Pappas, Loukas and and Panagopoulou, Vasiliki and Pyrgakis, Vlasios and Alexopoulos, Dimitrios and and Stefanadis, Christodoulos and Cleman, Michael W.",
    journal = "JACC Cardiovascular Interventions",
    year = "2013",
    volume = "6",
    number = "3",
    pages = "267-273",
    publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",
    issn = "1936-8798",
    doi = "10.1016/j.jcin.2012.11.005",
    keywords = "fentanyl; midazolam; percutaneous coronary intervention; radial artery;
spasm",
    abstract = "Objectives The aim of this study was to test the hypothesis that
moderate procedural sedation can reduce the incidence of radial artery
spasm.
Background Transradial access for left heart catheterization and
percutaneous coronary intervention is increasingly used for emergent and
elective procedures, in lieu of the femoral approach. However, increased
rates of access site crossover have been reported, with radial artery
spasm being a major contributor to this effect.
Methods Patients undergoing elective transradial percutaneous coronary
intervention were prospectively randomized to receive fentanyl and
midazolam during the procedure or no treatment (control subjects). The
primary endpoint was angiographically confirmed radial artery spasm.
Patient discomfort was quantified with a visual analogue scale.
Results Two thousand thirteen patients (age 64.5 +/- 8.4 years) were
randomized. Spasm occurred in 2.6% of the treatment group versus 8.3%
of control subjects (p < 0.001; odds ratio [OR]: 0.29). The number
needed to treat to avoid 1 case of spasm was 18 (95% confidence
interval [CI]: 12.9 to 26.6). The access site crossover rate was 34%
lower in the treatment group: 9.9% versus 15.0% (OR: 0.62; 95% CI:
0.48 to 0.82). Patient discomfort visual analogue scale score was 18.8
+/- 12.5 in the treatment group versus 27.4 +/- 17.4 in control subjects
(p < 0.001). No significant differences were observed in the 30-day rate
of death or repeat hospital stay for any cause: 4.6% versus 4.5% (OR:
1.02; 95% CI: 0.67 to 1.56).
Conclusions Routine administration of relatively low doses of an
opioid/benzodiazepine combination during transradial interventional
procedures is associated with a substantial reduction in the rate of
spasm, the need for access site crossover, and the procedure-related
level of patient discomfort. (J Am Coll Cardiol Intv 2013; 6: 267-73)
(C) 2013 by the American College of Cardiology Foundation"
}