Periprocedural rescue antiemetic administration during radiologic procedures performed under conscious sedation.

BACKGROUND: This study aimed to determine the incidence and clinical predictors of periprocedural rescue antiemetic administration during radiologic procedures performed under conscious sedation. METHODS: We performed a retrospective review of adult patients who underwent radiologic procedures under conscious sedation with midazolam and/or fentanyl between May 6, 2018, and December 31, 2024. Rescue antiemetics was defined as the use of an antiemetic during the procedure or recovery period. A modified Apfel score (excluding need for postprocedural opioids) was calculated. Logistic regression was used to assess the association of clinical characteristics with the need for rescue antiemetics. RESULTS: Among 21,343 unique patients, 990 (4.64%; 95% confidence interval [CI] 4.34-4.93) were administered a rescue antiemetic. Clinical factors associated with the need for rescue antiemetics included female sex (adjusted odds ratio [OR], 2.31; 95% CI, 1.99-2.67), history of postprocedural nausea and vomiting (OR, 1.99; 95% CI, 1.59-2.48), younger age (OR, 0.84 per decade of life; 95% CI, 0.81-0.88), procedural duration (OR, 1.78 per hour; 95% CI, 1.60-1.99), and fentanyl dose (OR, 1.12 per 25 mcg; 95% CI, 1.07-1.16). Risk increased with higher modified Apfel scores. Duration of recovery was longer among patients who were administered vs not administered a rescue antiemetic (median duration 116 [73, 165] vs 47 [27, 100] minutes, P < 0.001). DISCUSSION: Rescue antiemetic administration during radiologic procedures with conscious sedation complicates <5% of cases. Risk factors for rescue antiemetics are similar to those for postprocedural nausea and vomiting following general anesthesia.