Radiologist-guided Analgosedation with Ketamine/Midazolam: A Feasible Strategy to Expand Percutaneous Tumor Ablation Capacity

Purpose: Percutaneous thermal tumor ablation is an established oncologic treatment, but rising case numbers and limited anesthesia resources increasingly restrict procedural capacity. Radiologist-guided analgosedation may offer a pragmatic alternative to general anesthesia for selected ablation procedures. This study evaluates the safety, technical success, and impact on procedural throughput of performing microwave (MWA) and radiofrequency ablation (RFA) of hepatic, renal, and osseous tumors under analgosedation with midazolam and S-ketamine. Materials and Methods: In this retrospective single-center study, 140 percutaneous tumor ablations performed in 115 patients under radiologist-guided analgosedation between January 2022 and July 2024 were analyzed. The primary endpoint was the occurrence of sedation-related complications. Secondary endpoints included technical success, ablation-related complications, and changes in procedural volume compared with ablations performed under general anesthesia. Technical success was defined as complete tumor ablation with an adequate safety margin. Results: Of 115 planned patients, 113 (98.3%) were completed as intended. No major complications occurred. One minor complication (subcapsular hepatic hematoma, CIRSE grade 1) was observed. Four patients (3.5%) experienced transient post-interventional vomiting. No respiratory, cardiovascular, or anaphylactic adverse events were recorded. Transitioning from general anesthesia to analgosedation resulted in a significant increase in procedural volume from 2.1 to 6.3 ablations per month (p < 0.05). Mean in-room time was significantly shorter under analgosedation compared with general anesthesia (42 ± 34 min vs. 98 ± 42 min; p < 0.05). Conclusion: Radiologist-guided analgosedation with midazolam and S-ketamine is a feasible and safe approach for percutaneous thermal ablation of liver, kidney, and bone tumors. It enables high technical success without increasing complication rates and can substantially expand procedural capacity where anesthesiology resources are limited. Adequate training, structured workflows, and robust emergency preparedness are essential for safe implementation. Key Points: · Given the limited resources available for anaesthesia and the increasing demand for minimally invasive therapeutic procedures, the question of alternative concepts arises.. · At present, there is a lack of scientific research on the feasibility of percutaneous thermal ablation under analgosedation.. · This study demonstrated that percutaneous thermal tumour ablation under analgosedation is an effective method of achieving complete tumour ablation without increasing the rate of complications.. · It was shown that the use of analgosedation with S-ketamine and midazolam could increase procedural number of percutaneous thermal ablation procedures and therefore could reduce waiting times.. Citation Format: · Beeskow AB, Struck MF, Elkilany A et al. Radiologist-guided Analgosedation with Ketamine/Midazolam: A Feasible Strategy to Expand Percutaneous Tumor Ablation Capacity. Rofo 2026; DOI 10.1055/a-2786-2622.