Canadian Radiology Residents' Knowledge of Sedation and Analgesia: A Web-Based Survey

Objective: An increasing number of procedures in the radiology department require the use of conscious sedation, with the agents often administered by the radiologist. We sought to determine the level of understanding of the nature and use of such agents in Canadian radiology residents. Methods: A Web-based questionnaire was distributed to residents from 8 Canadian radiology residency programs. The questions concerned the pharmacology of common medications for conscious sedation, their indications and appropriateness for use, and the experience and attitudes of residents toward formal training in conscious sedation. Results: A total of 178 surveys were dispersed and yielded an adjusted response rate of 51%. Most residents stated that they had not received any formal training in conscious sedation (65%) and were in favour (68%) of having such training. Although the residents typically correctly prescribed appropriate dosages of lorazepam (54%), midazolam (51%), and fentanyl (58.7%), excessively high dosages of midazolam were ordered by 15.9% of the residents. Knowledge regarding the onset of action and duration of commonly used medications was poor. Residents gave the correct response with regard to duration of action for lorazepam (23.8%), midazolam (31.9%), diazepam (15.9%), and fentanyl (28.6%). The correct responses to onset of action were as follows: for fentanyl, 22.2%; for midazolam, 19.1%; for lorazepam, 6.35%; and for diazepam, 11.1%. Residents were uncertain regarding the maximum dosage of local anesthetics that a patient could receive, with 1.5% and 20.6% correct responses regarding bupivacaine and lidocaine, respectively. Conclusion: Despite the recent publication of conscious sedation guidelines for nonanesthesiologists, this survey suggests that Canadian radiology residents are not receiving adequate training in the use of medications required for conscious sedation.