Anesthesia for therapeutic interventional radiological procedures involving the venous/lymphatic system (not to include access to the central circulation); intrahepatic or portal circulation (eg, transvenous intrahepatic portosystemic shunt[s] [TIPS])
CPT4 code
Name of the Procedure:
Anesthesia for Therapeutic Interventional Radiological Procedures Involving the Venous/Lymphatic System (excluding access to central circulation); Intrahepatic or Portal Circulation (e.g., Transjugular Intrahepatic Portosystemic Shunt [TIPS]).
Summary
This procedure involves the administration of anesthesia for various therapeutic interventional radiological procedures targeting the venous, lymphatic, intrahepatic, or portal circulatory systems. The anesthesia ensures that the patient is comfortable and pain-free during these specialized medical interventions, which are performed using imaging guidance.
Purpose
The primary goal is to facilitate the performance of therapeutic radiological interventions by ensuring patient comfort and immobilization. These procedures commonly address venous issues, lymphatic malformations, and complications related to liver circulation, such as portal hypertension managed with TIPS.
Indications
- Patients with chronic venous insufficiency or thrombosis.
- Individuals with lymphatic malformations.
- Those needing interventions for intrahepatic or portal hypertension.
- Candidates for procedures like TIPS to manage complications from liver disease.
Preparation
- Patients may be required to fast for at least 6-8 hours prior.
- Cessation of certain medications (e.g., blood thinners) may be necessary.
- Pre-procedure imaging, blood tests, and assessments to evaluate anesthesia risk.
Procedure Description
Pre-Procedure Preparation:
- Placement of an intravenous (IV) line.
- Administration of premedication, if necessary.
Anesthesia Administration:
- General anesthesia or conscious sedation based on the procedural requirement.
- Monitoring of vital signs (heart rate, blood pressure, oxygen levels).
Radiological Intervention:
- Use of imaging techniques like fluoroscopy or ultrasound to guide the procedure.
- Performance of the therapeutic intervention, such as placing a shunt (TIPS) or treating a venous malformation.
Post-Procedure Care:
- Gradual weaning off anesthesia.
- Monitoring in a recovery area until the patient is stable.
Duration
The procedure typically takes between 2 to 4 hours, depending on the complexity.
Setting
Usually performed in a hospital’s radiology suite or interventional radiology lab.
Personnel
- Anesthesiologists or nurse anesthetists.
- Interventional radiologists.
- Radiologic technologists.
- Nursing staff specialized in recovery and post-procedure care.
Risks and Complications
- Common risks include nausea, vomiting, and temporary confusion post-anesthesia.
- Rare but serious complications might involve allergic reactions to anesthesia, respiratory issues, or cardiovascular events.
- Procedure-specific risks like bleeding, infection, or injury to surrounding tissues.
Benefits
- Ensures the patient's comfort and pain management during complex interventions.
- Allows precise performance of life-saving or health-improving procedures.
- Reduction in patient movement, leading to higher procedural accuracy.
Recovery
- Patients often recover within a few hours but might need overnight observation.
- Post-procedure instructions may include resting, hydration, and avoiding strenuous activities.
- Follow-up visits to monitor the success of the intervention and manage any side effects.
Alternatives
- Local anesthesia or moderate sedation for simpler procedures.
- Medical management alone for certain conditions.
- Surgical interventions as alternatives to radiological procedures, depending on the case.
Patient Experience
During the procedure, the patient will be asleep or sedated and should not feel pain. Post-procedure, mild discomfort or drowsiness is common but manageable with medication and care. The healthcare team will prioritize the patient’s comfort and address any concerns promptly.