Procedural sedation during transradial coronary angiography. Impact of opiod analgesia and inhalation sedation by 50% nitrous oxide/oxygen premix (Kalinox) on pain and radial artery spasm

Abstract

The aim of this study was to investigate the respective impact of opiods analgesia and inhalation sedation with a 50% nitrous oxide/oxygen premix (Kalinox) on pain and occurence of radial artery spasm (RAS) during transradial coronary procedures. Backgroud With respect to the transfemoral approach, transradial procedures enable a drastic reduction of bleeding events and are associated with a reduction of mortality. RAS is one of the most common complications and may lead to patient discomfort and procedural failure. Currently, there is no consensus on the optimal sedation protocol to avoid RAS. Consecutive patients undergoing transradial coronary angiography were prospectively enrolled in one single center study (Nouvel Hôpital Civil, Strasbourg, France). Patients were allocated to opioids analgesia or inhalation sedation with Kalinox. The primary endpoints of the study were the incidence of a pain scale more than or equal to 5 and the occurrence of RAS. The secondary endpoint included the occurrence of side effects including nausea, vomiting, dizziness or faintness and headache. From September 2016 to February 2017 a total of 325 patients were enrolled (Opiods Analgesia n = 185, Kalinox n = 140). RAS and Pain scale ≥ 5 rates were not significantly differents in Opiods Analgesia and Kalinox groups (respectively 13.5% vs. 10% and 16.2% vs. 11.4%). Headache was more frequently observed in the kalinox group (6.4% vs. 0%; P = 0.002). By multivariate analysis, female gender, BMI < 25 kg/m 2 , puncture difficulty, the use of plastic needle and 6F sheath were indentified as independent predictors of RAS. Procedural inhalation sedation by Kalinox is as safe as Opiods Analgesia during transradial coronary angiography.