Anesthesia technique and patient and bronchoscopist satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation

Vilà, Esther; Mases, A.; Fernández, Juan Senís; Vela, Enrique; Gallart, L.

doi:10.1097/00003643-201106001-00246

Cited by 4 publications

(4 citation statements)

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“…A sample size calculation was performed, assuming a 48% desaturation incidence in the standard oxygen therapy group compared with a 15% incidence in the HFNO group. It was calculated that a total of 30 participants in each group would provide 80% power at a significance level of 0.05.…”

Section: Methodsmentioning

confidence: 99%

“…Sedation for EBUS should make the procedure tolerable for the patient, reduce or eliminate coughing to maximise procedural safety, while avoiding hypoxaemia (which may be life‐threatening). A combination of sedative agents and opioids are commonly used, although previous trials reported that this combination led to desaturation in up to 45% of patients , either due to airway obstruction or hypoventilation by direct central suppression of ventilation.…”

Section: Introductionmentioning

confidence: 99%

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A randomised controlled trial comparing high‐flow nasal oxygen with standard management for conscious sedation during bronchoscopy

et al. 2017

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Traditional conscious sedation for endobronchial ultrasound procedures places patients at risk of desaturation, and high-flow nasal oxygen may reduce the risk. We designed a parallel-group randomised controlled trial of high-flow nasal oxygen at a flow rate of 30-70 l.min via nasal cannulae, compared with standard oxygen therapy at 10 l.min via a bite block in adults planned for conscious sedation for endobronchial ultrasound. The primary outcome was the proportion of patients experiencing desaturation (defined as SpO < 90%). Secondary outcomes included oxygen saturation after pre-oxygenation, lowest oxygen saturation during procedure, number of hypoxic episodes, duration of hypoxia, end-procedure end-tidal CO , satisfaction scores and complications. Thirty participants were allocated to each group. Baseline patient characteristics, procedure time and anaesthetic agents used were similar between the groups. Desaturation occurred in 4 out of 30 patients allocated to the high-flow nasal oxygen group, compared with 10 out of 30 allocated to the standard oxygenation group, a non-significant difference (p = 0.07) with intention to treat analysis. The difference was significant (p = 0.047) when using a per-protocol analysis. Oxygen saturation after pre-oxygenation and the lowest oxygen saturation during procedure were significantly higher in the high-flow nasal oxygen group compared with the standard oxygenation group; median (IQR [range] 100 (99-100 [93-100]) vs. 98 (97-99 [94-100]), p = 0.0001 and 97.5 (94-99 [77-100]) vs. 92 (88-95 [79-98]), p < 0.001, respectively. There were no differences in other secondary outcomes. Although high-flow nasal oxygen may prevent desaturation due to some causes, it does not protect against hypoxaemia in all circumstances.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial comparing high‐flow nasal oxygen with standard management for conscious sedation during bronchoscopy

et al. 2017

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“…Various types of anesthesia have been used like local anesthetic spray to the oropharynx with/without moderate sedation, but the diagnostic yield has been less accurate due to noncooperation of the patients. 11 Conscious sedation is also preferred in many centers depending on the case load of patients undergoing the procedure and also availability of qualified anesthesiologist to administer the sedation. 12,13 But general anesthesia in the operation theatre seems to be the ideal setting as it provides maximum safety and comfort to the patient and the budding pulmonologist with their learning curve and ensures maximum diagnostic yield.…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of endobronchial ultrasound guided trans bronchial needle aspiration: Our experience with laryngeal mask airway

Kedlaya¹,

Rani²,

Devaraj³

et al. 2020

IJCA

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Introduction: Endobronchial Ultrasound Guided Trans bronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic modality for evaluating intra thoracic lymph nodes, becoming one of the important tool in the armamentarium of pulmonologists. The size of the fiberscope and sharing of the airway with the bronchoscopist poses unique challenges to the anesthesiologist. In light of these developments it is important to develop an office based anesthesia technique for this relatively new procedure. Hence we did this descriptive cohort study. Aim: To describe the accuracy and anaesthetic management of EBUS-TBNA as a day care procedure, done with general anesthesia (GA). Materials and Methods: Data was collected from January 2017 to December 2017 at our institute from patients who underwent EBUS-TBNA under GA using second generation laryngeal mask airway (LMA). Specifically, hemodynamic status, Oxygen saturation, duration of the procedure, diagnostic yield and complications of the procedure were recorded. Results: 23 patients underwent EBUS-TBNA under GA. All patients were found to be hemodynamically stable with fluctuations in blood pressure and heart rate being less than 20% from the baseline with no episodes of desaturation .The average number of biopsies taken is 3.3, with average duration of the procedure being 67.0±17.6 (mean±SD) minutes. The incidence of post procedural complications like cough and sore throat were minimal. Successful diagnostic yield was found in all cases with no incidence of recall of the procedure. Conclusion:The performance of EBUS-TBNA under general anesthesia with LMA provides great hemodynamic stability and adequate ventilation in a shared airway. It demonstrates excellent diagnostic accuracy. It provides comfort to the patient and the good examination conditions to the bronchoscopist. Clinical Significance: Use of P-LMA solves the dilemma of managing ventilation during EBUS TBNA without affecting the diagnostic yield of the procedure.

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“…The diagnostic yield and access to the number of lymph nodes sampled using deep sedation is superior to moderate sedation for end bronchial ultrasound trans bronchial needle aspiration. 3,4 In a randomized trial of end bronchial ultrasoundguided Tran's bronchial needle aspiration under general anaesthesia (GA) versus moderate sedation (MS) the diagnostic yield was 70.7% and 68.9% for the GA group and MS group, respectively. 5 Use of i-gel is better than PLMA in terms of faster insertion and ease of insertion.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for Endobronchial Ultrasound-Guided Procedures Using i-gel

M¹,

Teresa²

2019

jebmh

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BACKGROUND Advancements in the field of EBUS (endobronchial ultrasound) and its applications in the field of interventional pulmonology made it important to develop an officebased outpatient anaesthesia technique for this minimally invasive procedure. The increasing scope of applications in the field of EBUS made the stability and necessity of airway access as one of the determining factors not only for the safety of the patient, but also to cater to the widened horizon of its applications including TBNA, Cryotherapy etc. i-gel as supraglottic airway device can be used for therapeutic intervention procedures like EBUS, TBNA, while providing a secure airway to the anesthetized patient. We wanted to evaluate the efficacy of i-gel for EBUS procedures. METHODS For this observation study, 60 patients of ASA grade: 1-3 scheduled for elective EBUS were included. Patients with limited mouth opening or with airway abscess were excluded from the study. Preoperative oxygen saturation, chest X-ray, ECG, CT chest scan, intra-operative ease of airway access, airway stability (adequate oxygen saturation) were tested taking into consideration the surgeon's comfort, need for emergency treatment or abandoning procedure, post-operative time for extubation, associated complications, readiness for discharge and surgeon. RESULTS The incidence of adverse events during peri-operative period was low and none of the patients suffered hypoxia (SpO2 <90%). During emergency, 4 patients had cough, 1 patient had bronchospasm and 2 patients complained of sore throat. No considerable variations of baseline haemodynamics were seen with insertion or during removal of i-gel. CONCLUSIONS i-gel as supraglottic airway device can be used for therapeutic intervention procedures like EBUS, TBNA, while providing a secure airway to the anesthetized patient.

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Anesthesia technique and patient and bronchoscopist satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation

Cited by 4 publications

References 0 publications

A randomised controlled trial comparing high‐flow nasal oxygen with standard management for conscious sedation during bronchoscopy

A randomised controlled trial comparing high‐flow nasal oxygen with standard management for conscious sedation during bronchoscopy

Anaesthetic management of endobronchial ultrasound guided trans bronchial needle aspiration: Our experience with laryngeal mask airway

Anaesthesia for Endobronchial Ultrasound-Guided Procedures Using i-gel

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