Prospective IR-led Sedation Feasibility

Inclusion Criteria: * Age 18 and older * Planned to undergo an image-guided IR procedure for which general anesthesia would ordinarily be requested, as determined by the performing IR physician * Determined by the performing IR physician to be an appropriate candidate for attempted IR-led ketamine- based deep sedation, with anesthesiology available for escalation if needed * Ability to provide written informed consent for participation in a study involving deep sedation Exclusion Criteria: * Ingestion of solid food within 6-8 hours prior to the procedure, per institutional deep sedation guidelines * Known allergy or hypersensitivity to ketamine, fentanyl or midazolam * Inability to provide informed consent or lack of decision-making capacity * Prisoner status * Uncontrolled hypertension or other condition in which ketamine-associated sympathetic stimulation would pose unacceptable risk (e.g., aortic dissection, acute myocardial infarction) * Pregnancy or lactation, due to contraindication to ketamine/midazolam * History of schizophrenia or other psychotic disorders for which ketamine is contraindicated * Medical conditions that, in the judgment of the performing IR physician in consultation with anesthesiology, preclude safe administration of ketamine-based deep sedation