Interventional radiology (IR) has become a cornerstone of modern minimally invasive therapy, offering image‑guided procedures for vascular, oncologic, and pain conditions such as trans arterial chemoembolization, radiofrequency ablation, and neurointerventional thrombectomy. These procedures are increasingly complex and are often performed on elderly patients with multiple comorbidities, raising the perioperative risk and making robust anaesthesiology support essential for patient safety and procedural success [1,2]. Although IR procedures are technically minimally invasive, they can be prolonged, painful, and anxiety‑provoking, especially in critically ill or frail patients. Without adequate anesthetic management, patients may experience discomfort, movement during imaging, hemodynamic instability, or respiratory compromise, all of which can jeopardize outcomes and increase complications. Anesthesiology support in IR therefore extends beyond general anesthesia to include monitored anesthesia care (MAC), regional anesthesia, and comprehensive perioperative management, ensuring tailored sedation, continuous monitoring, and rapid response to adverse events [3-5]. Anaesthesiologists play a key role in pre‑procedure assessment and optimization, intra‑procedural hemodynamic and respiratory stability, and post‑procedural pain control and early recovery. Their involvement is particularly important in high‑risk procedures such as TIPS, complex embolization’s, and mechanical thrombectomy, where stable conditions and immobility are critical for technical success and patient safety. Studies show that anaesthesiologist‑managed sedation and anesthesia in IR are associated with lower complication rates, shorter recovery times, and higher patient satisfaction [6-9]. Despite this evidence, many IR departments still lack dedicated anesthesiology coverage, especially outside regular hours, and sedation is often administered by non‑anaesthesiologist teams, increasing the risk of oversedation and delayed recognition of complications [10-11]. This study aims to evaluate how structured anesthesiology support affects patient outcomes in a tertiary IR unit, by comparing complication rates, recovery profiles, pain scores, and satisfaction between procedures performed with and without dedicated anesthesiology involvement.

This prospective observational cohort study was conducted in the Interventional Radiology (IR) department of a tertiary care teaching hospital over a 12-month period (January–December 2024). Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent was secured from all participants. Adult patients (≥18 years) undergoing elective or urgent IR procedures were included. Patients refusing consent, unable to provide consent, undergoing procedures under local anesthesia alone, or whose procedures were cancelled were excluded. Participants were divided into two groups: Group A, where procedures were conducted with dedicated anesthesiology support, and Group B, where sedation and analgesia were administered by the IR team without anesthesiologist involvement. Demographic data, clinical characteristics, comorbidities, ASA physical status, procedure type, duration, imaging modality, and contrast use were recorded using a standardized case record form. Details of anesthetic technique, sedative and analgesic agents, and monitoring parameters were documented. Group A patients received anesthesia per institutional protocols with comprehensive monitoring, including ECG, non-invasive blood pressure, pulse oximetry, and capnography, whereas Group B patients were monitored primarily with ECG, blood pressure, and pulse oximetry. The primary outcome was the incidence of major peri-procedural complications. Secondary outcomes included minor complications, procedural success rate, recovery profile, pain scores, patient satisfaction, length of hospital stay, and 30-day readmission rates. Data were analyzed using SPSS version 28.0. Continuous variables were expressed as mean ± standard deviation or median (interquartile range), and categorical variables as frequencies and percentages. Appropriate statistical tests were applied for group comparisons, with multivariable logistic regression used to adjust for confounding factors. A p-value <0.05 was considered statistically

The study included 500 patients: 250 in the anesthesiology supported group (Group A) and 250 in the non anesthesiology supported group (Group B) . Baseline characteristics were well balanced between the two groups, with no significant differences in age, sex, BMI, ASA class, or major comorbidities (p > 0.05 for all) . Table 1: Baseline Characteristics of Study Population Variable Group A (n=250) Group B (n=250) p value Age (years), mean ± SD 61.2 ± 12.4 60.8 ± 13.1 0.68 Male, n (%) 138 (55.2%) 135 (54.0%) 0.78 BMI (kg/m²), mean ± SD 26.8 ± 4.5 27.1 ± 4.8 0.42 ASA class III–IV, n (%) 142 (56.8%) 138 (55.2%) 0.70 Hypertension, n (%) 165 (66.0%) 160 (64.0%) 0.62 Diabetes mellitus, n (%) 98 (39.2%) 95 (38.0%) 0.78 Coronary artery disease, n (%) 72 (28.8%) 70 (28.0%) 0.83 Chronic kidney disease, n (%) 58 (23.2%) 55 (22.0%) 0.74 COPD, n (%) 45 (18.0%) 43 (17.2%) 0.81 Table 1 summarizes the baseline demographic and clinical characteristics of patients in Group A and Group B . The two groups were comparable with respect to all assessed variables. The mean age of participants was similar between Group A (61.2 ± 12.4 years) and Group B (60.8 ± 13.1 years), with no statistically significant difference (p = 0.68). Male patients constituted a comparable proportion in both groups (55.2% vs. 54.0%; p = 0.78). Baseline body mass index was also similar between the two groups, with mean BMI values of 26.8 ± 4.5 kg/m² in Group A and 27.1 ± 4.8 kg/m² in Group B (p = 0.42). The proportion of patients classified as ASA physical status III–IV did not differ significantly (56.8% in Group A vs. 55.2% in Group B; p = 0.70), indicating comparable peri-procedural risk profiles. Similarly, the prevalence of hypertension was evenly distributed between the groups (66.0% vs. 64.0%; p = 0.62). Overall, the absence of statistically significant differences across baseline variables suggests that both groups were well matched, thereby minimizing confounding and allowing meaningful comparison of procedural outcomes and recovery profiles. Table 2: Procedure and Anesthetic Characteristics Variable Group A (n=250) Group B (n=250) p value Vascular interventions, n (%) 110 (44.0%) 108 (43.2%) 0.85 Oncologic interventions, n (%) 85 (34.0%) 83 (33.2%) 0.84 Neurointerventional procedures, n (%) 30 (12.0%) 28 (11.2%) 0.79 Pain/orthopedic procedures, n (%) 25 (10.0%) 31 (12.4%) 0.36 Procedure duration (min), mean ± SD 78.5 ± 25.3 76.8 ± 26.1 0.41 General anesthesia, n (%) 120 (48.0%) 10 (4.0%) <0.001 Monitored anesthesia care, n (%) 110 (44.0%) 180 (72.0%) <0.001 Local anesthesia only, n (%) 20 (8.0%) 60 (24.0%) <0.001 Table 2 compares the procedural and anesthetic characteristics between Group A and Group B. The distribution of procedure types—including vascular, oncologic, neurointerventional, and pain/orthopedic interventions—was similar between the two groups, with no statistically significant differences, indicating comparable procedural complexity. Mean procedure duration was also comparable (78.5 ± 25.3 minutes in Group A vs. 76.8 ± 26.1 minutes in Group B; p = 0.41). In contrast, significant differences were observed in anesthetic management. General anesthesia was used predominantly in Group A compared to Group B (48.0% vs. 4.0%; p < 0.001), while monitored anesthesia care and local anesthesia alone were more frequently employed in Group B (p < 0.001). These findings reflect differing anesthesia support strategies between the groups while maintaining similar procedural profiles. Table 3: Perioperative Complications Complication Group A (n=250) Group B (n=250) p value Adjusted OR (95% CI) Major complications, n (%) 18 (7.2%) 42 (16.8%) <0.001 0.38 (0.21–0.69) Hypotension requiring vasopressors 8 (3.2%) 18 (7.2%) 0.03 0.42 (0.18–0.98) Hypoxia requiring oxygen/airway intervention 6 (2.4%) 16 (6.4%) 0.02 0.36 (0.14–0.92) Arrhythmias requiring treatment 3 (1.2%) 7 (2.8%) 0.18 0.41 (0.11–1.52) Myocardial infarction 1 (0.4%) 1 (0.4%) 1.00 1.00 (0.06–16.5) Minor complications, n (%) 45 (18.0%) 88 (35.2%) <0.001 0.41 (0.27–0.62) Nausea/vomiting 28 (11.2%) 52 (20.8%) 0.004 0.48 (0.30–0.77) Bradycardia 10 (4.0%) 22 (8.8%) 0.02 0.43 (0.20–0.92) Transient hypotension 15 (6.0%) 30 (12.0%) 0.02 0.46 (0.24–0.88) Respiratory depression 7 (2.8%) 18 (7.2%) 0.02 0.36 (0.15–0.86) Table 3 outlines the perioperative complications observed in Group A and Group B and demonstrates a significantly lower complication burden in the anesthesiology-supported group. Major complications occurred in 7.2% of patients in Group A compared with 16.8% in Group B, a difference that was statistically significant (p < 0.001). After adjustment for potential confounders, anesthesiology support was associated with a significantly reduced risk of major complications (adjusted OR 0.38; 95% CI 0.21–0.69). Specifically, hypotension requiring vasopressor support and hypoxia necessitating oxygen supplementation or airway intervention were significantly less frequent in Group A (p = 0.03 and p = 0.02, respectively). Although arrhythmias occurred less commonly in Group A, this difference did not reach statistical significance, and the incidence of myocardial infarction was identical in both groups. Minor complications were also significantly lower in Group A compared with Group B (18.0% vs. 35.2%; p < 0.001), with a corresponding reduction in adjusted odds (OR 0.41; 95% CI 0.27–0.62). Episodes of nausea and vomiting, bradycardia, transient hypotension, and respiratory depression were all significantly less frequent in Group A, indicating improved perioperative physiological stability with anesthesiology involvement. Overall, these findings suggest that anesthesiology-supported care in interventional radiology procedures is associated with a substantially reduced risk of both major and minor perioperative complications. Table 4: Procedural Success and Recovery Profile Outcome Group A (n=250) Group B (n=250) p value Procedural success, n (%) 242 (96.8%) 228 (91. 0.01 Table 4 compares procedural success and recovery outcomes between Group A and Group B. Procedural success was significantly higher in the anesthesiology-supported group, with successful completion achieved in 96.8% of cases in Group A compared to 91.2% in Group B (p = 0.01). This statistically significant difference indicates that the presence of dedicated anesthesiology support was associated with improved procedural success, likely due to better patient monitoring, optimized anesthesia management, and enhanced procedural conditions.

The present study demonstrates that structured anesthesiology support in interventional radiology (IR) is associated with significantly improved patient outcomes, including lower rates of major and minor complications, higher procedural success, faster recovery, better pain control, and greater patient satisfaction [1,2]. A nearly 50% reduction in major complications in the anesthesiology-supported group highlights the importance of continuous hemodynamic and respiratory monitoring, early detection of instability, and prompt intervention, particularly for hypotension and hypoxia, which are common and potentially life-threatening events in IR procedures [7–9]. The reduced incidence of minor complications such as nausea, vomiting, bradycardia, and respiratory depression further emphasizes the benefit of expert anesthetic management. Precise titration of sedatives and opioids, use of multimodal analgesia, and advanced monitoring, including capnography, contribute to improved peri-procedural stability and patient comfort [7–12]. Higher procedural success rates in the anesthesiology-supported group may be attributed to better patient immobility and fewer sedation-related interruptions, which are critical for technically demanding procedures [13–17]. Faster recovery and consistently lower pain scores observed in the anesthesiology-supported group reflect optimized anesthetic techniques and structured pain management strategies, facilitating early discharge and improved workflow in busy IR units [18–23]. Higher patient satisfaction further reinforces the role of anesthesiologists in enhancing procedural comfort and addressing anxiety through pre-procedural counselling [24,25]. Given the increasing complexity of IR procedures and the growing burden of elderly patients with multiple comorbidities, a tiered anesthesiology support model is recommended, with dedicated coverage for moderate- to high-risk interventions [26–28]. The integration of non-operating room anesthesia (NORA) services can optimize resource utilization while maintaining high safety standards [29,30].

Anesthesiology support in interventional radiology is associated with improved patient outcomes, including fewer peri-procedural complications, higher procedural success, faster recovery, better pain control, and greater patient satisfaction. The presence of an anesthesiologist enables individualized anesthesia care, continuous monitoring, and prompt management of hemodynamic and respiratory events, which is crucial for complex IR procedures. A tiered anesthesiology support model, prioritizing moderate- to high-risk interventions, along with standardized NORA protocols and close radiologist–anesthesiologist collaboration, can enhance patient safety and optimize resource utilization.

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