Comparison of Moderate versus Deep Sedation for Endobronchial Ultrasound Transbronchial Needle Aspiration

Yarmus, Lonny; Akulian, Jason; Gilbert, Christopher R.; Mathai, Stephen C.; Sathiyamoorthy, Srividya; Sahetya, Sarina K.; Harris, Kassem; Gillespie, Colin T.; Haas, Andrew R.; Feller‐Kopman, David; Sterman, Daniel H.; Lee, Hans J.

doi:10.1513/annalsats.201209-074oc

Cited by 95 publications

(93 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Concerning patient sedation, all centers in our study used conscious sedation with fentanyl and midazolam, obtaining overall an adequate sample rate of 90%, similar to that reported in the literature (16,17).…”

Section: Discussionmentioning

confidence: 52%

Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy

et al. 2017

View full text Add to dashboard Cite

Background: Multi-institutional studies of endobronchial-ultrasound transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging in lung cancer are scarce. It is unclear if the high diagnostic performance of EBUS-TBNA reported by experts' guidelines can be generally achieved. Methods: This is a retrospective study performed in five tertiary referral centers of thoracic surgery in Italy, to assess the EBUS-TBNA diagnostic performance in patients with non-small cell lung cancer (NSCLC). Patient inclusion criteria were: both genders; >18 years old; with suspect/confirmed NSCLC; undergoing EBUS-TBNA for mediastinal node enlargement at computed tomography (size >1 cm, ≤3 cm) and/or pathological uptake at positron emission tomography. Altogether we included 485 patients [male, 366; female, 119; median age, 68 years (IQR, 61-74 years)] undergoing mediastinal staging between January 2011 and July 2016.All EBUS-TBNAs were performed by experienced bronchoscopists, without pre-defined quality standards.Depending on usual practice in each center, EBUS-TBNA was done under conscious sedation, with 21-or 22-Gauge (G) needle, and specimen preparation was cell-block, or cytology slides, or core-tissue. Sampling was classified inadequate in absence of lymphocytes, or when sample was insufficient. We analyzed the EBUS-TBNA procedural steps likely to influence the rate of adequate samplings (diagnostic yield).Results: EBUS-TBNA sensitivity, negative predictive value (NPV) and accuracy respectively were 90%, 78% and 93% in the whole cohort. At multivariate analysis, use of 21-G needle was associated with better diagnostic yield (P<0.001). Center and specimen processing technique were not independent factors affecting EBUS-TBNA diagnostic yield. Conclusions: In this multicentric study, EBUS-TBNA was a highly sensitive and accurate method for NSCLC mediastinal node staging. Results indicate better performance of EBUS-TBNA with 21-G needle, and suggest that specimen processing technique could be chosen according to the local practice preference.

show abstract

Section: Discussionmentioning

confidence: 52%

Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy

et al. 2017

View full text Add to dashboard Cite

show abstract

“…sum of true positive and true negative cases) was observed in a percentage (55%) lower than several data in literature [22][23][24][25]. Better diagnostic performance was reported by Casal et al (69% diagnostic yield) but all the procedures were carried out by the same expert operator [24].…”

Section: Original Articlementioning

confidence: 60%

“…Better diagnostic performance was reported by Casal et al (69% diagnostic yield) but all the procedures were carried out by the same expert operator [24]. A diagnostic yield of 66% was recorded by Yarmus et al, but all operators had similar and advanced expertise [25]. A recent systematic review reports an overall diagnostic yield of 52.3-100% for deep sedation and of 46.1-85.7% for moderate sedation [26].…”

Section: Original Articlementioning

confidence: 96%

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Agostini¹,

Facciolongo²,

Lusuardi

et al. 2017

Monaldi Arch Chest Dis

View full text Add to dashboard Cite

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is usually performed under general anesthesia or deep sedation with drugs such as Propofol that, at least in Italy, can be administered only by an anesthesiologist. Aim of the study was to assess conscious sedation feasibility, safety and tolerability using meperidine and midazolam as administered by Pulmonologist and relevant impact on the efficiency of the sampling procedures.All patients undergoing EBUS-TBNA from February 2013 to July 2014 were examined retrospectively. Efficiency using Meperidine and Midazolam during EBUS-TBNA has been assessed: completion of lymphnodal sampling, sampling adequacy, diagnostic yield, cough during endoscopic procedure complications and need for procedure repetition with Anesthesiology assistance. Patient satisfaction and cost/effectiveness were also evaluated. One hundred and thirty-four consecutive patients were considered; 97.7% completed the procedure. In 96.9% of cases the prefixed program of lymph-nodal sampling was accomplished. Sampling adequacy was 92,4%. Diagnostic yield was 55%. In 94.7% of cases cough was absent or did not interfere with EBUS-TBNA. The need to repeat the endoscopic procedure occurred in 6 cases but only in 2 the presence of an Anesthesiologist was required. Patient satisfaction was very high, with 95.9% of subjects reporting they would "definitely return". A 27% cost reduction was calculated. EBUS-TBNA under conscious sedation using Meperidine and Midazolam prescribed and administered by pulmonologist without the Anesthesiologist assistance, revealed to be a safe, well tolerated and cost saving procedure. The efficiency of sampling was good, apart from a relatively low diagnostic yield due to different expertise of operators.

show abstract

“…A remaining question concerns the impact of the type of sedation on the diagnostic yield of EBUS-TBNA. Although initial retrospective analysis of these two types of sedation suggested there was no significant difference in the diagnostic yield, a more recent study from Yarmus and coworkers reported a much greater diagnostic yield when EBUS was performed under GA (6). These findings may generate concern among many physicians who perform EBUS-TBNA in nontertiary settings where access to GA is limited or not available.…”

mentioning

confidence: 99%

Randomized Trial of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration under General Anesthesia versus Moderate Sedation

Casal

Lazarus²,

Kuhl

et al. 2015

Am J Respir Crit Care Med

133

136

View full text Add to dashboard Cite

Rationale: Data about the influence of the type of sedation on yield, complications, and tolerance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) are based mostly on retrospective studies and are largely inconsistent.Objectives: To determine whether the type of sedation influences the diagnostic yield of EBUS-TBNA, its complication rates, and patient tolerance.Methods: Patients referred for EBUS-TBNA were randomized (1:1) to undergo this procedure under general anesthesia (GA) or moderate sedation (MS). Pathologists were blinded to group allocation.Measurements and Main Results: The main outcome was "diagnostic yield," defined as the percentage of patients for whom EBUS-TBNA rendered a specific diagnosis. One hundred and fortynine patients underwent EBUS-TBNA, 75 under GA and 74 under MS. Demographic and baseline clinical characteristics were well balanced. Two hundred and thirty-six lymph nodes (LNs) and six masses were sampled in the GA group (average, 3.2 6 1.9 sites/ patient), and 200 LNs and six masses in the MS group (average, 2.8 6 1.5 sites/patient) (P = 0.199). The diagnostic yield was 70.7% (53 of 75) and 68.9% (51 of 74) for the GA group and MS group, respectively (P = 0.816). The sensitivity was 98.2% in the GA group (confidence interval, 97-100%) and 98.1% in the MS group (confidence interval, 97-100%) (P = 0.979). EBUS was completed in all patients in the GA group, and in 69 patients (93.3%) in the MS group (P = 0.028). There were no major complications or escalation of care in either group. Minor complications were more common in the MS group (29.6 vs. 5.3%) (P , 0.001). Most patients stated they "definitely would" undergo this procedure again in both groups (P = 0.355).Conclusions: EBUS-TBNA performed under MS results in comparable diagnostic yield, rate of major complications, and patient tolerance as under GA. Future prospective multicenter studies are required to corroborate our findings. Clinical trial registered with www.clinicaltrials.gov (NCT 01430962).

show abstract

Comparison of Moderate versus Deep Sedation for Endobronchial Ultrasound Transbronchial Needle Aspiration

Abstract: Diagnostic yield and number of lymph nodes sampled using deep sedation is superior to moderate sedation in patients undergoing EBUS-TBNA. Prospective studies accounting for other factors including patient selection and cost are needed.

Cited by 95 publications

References 20 publications

Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy

Multicentric study of endobronchial ultrasound-transbronchial needle aspiration for lung cancer staging in Italy

Endobronchial ultrasound-guided transbronchial needle aspiration under conscious sedation with meperidine and midazolam

Randomized Trial of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration under General Anesthesia versus Moderate Sedation

Contact Info

Product

Resources

About