Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia

Abstract

Background: Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA. Methods: A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators’ difficulties were defined as secondary outcomes. Results: Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties. Conclusions: The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients’ comfort and satisfaction.

Dexmedetomidine sedation for endobronchial ultrasound-guided transbronchial needle aspiration, a randomised controlled trial

“…All but one retrospective study reported that diagnostic yield and patient tolerance under deep propofol sedation was equivalent to that under moderate midazolam sedation [ 37 – 40 ]. Prospective randomised controlled trials comparing the use of propofol for general anaesthesia and midazolam for moderate sedation were also comparable in terms of diagnostic yield, major complications and patient tolerance [ 31 , 41 ]. In the current study, we compared the diagnostic yield and detailed sedative profiles among patients undergoing dexmedetomidine or propofol sedation from the perspective of patients, bronchoscopists and physicians overseeing sedation.…”

Non-intubated general anesthesia based on Bi-spectral index monitoring

“…[ 1 2 3 ] Anesthetic considerations for the procedure have been an area of much interest and there are plenty of studies making comparisons between different methods. [ 4 5 6 7 8 9 ] EBUS-TBNA under GA as well as with moderate sedation (MS) seems to be safe, [6] effective, and with good diagnostic yield but with comparable disadvantages and advantages, one of them being the higher cost. [10] …”

“…In their previous studies, Fernandes et al [6] and Casal et al [8] compared the application of GA and MS in the process of EBUS-TBNA. They pointed out that because some pulmonary physicians did not accept GA, they turned to explore a suitable method for MS of EBUS-TBNA.…”

“…Inputting the keyword “EBUS-TBNA” to search in PubMed generates 1002 related research documents, while imputing “EBUS-TBNA+GA (general anesthesia)” produces 7 related research documents. Among these 7 studies, 1 addresses the complications during EBUS-TBNA [2] ; 2 focus on the impact of different TBNA methods on diagnosis[ 2 3 ]; 4 remaining articles include a study from 2010 dealing with the use of pethidine for EBUS-TBNA,[ 4 5 6 7 ] and other 3 papers that focus on the comparative study of GA and MS (moderate sedation) or deep sedation (DS). [ 5 6 8 ] The above results show that there are many methods available for EBUS-TBNA, including moderate sedation, deep sedation, general anesthesia, and monitoring anesthesia.…”

Role of Bronchoscopic Techniques in the Diagnosis of Thoracic Sarcoidosis

“…Then, aspirated specimens are expelled into a container with preservative liquid, and a cytoblocis prepared and stained for subsequent cytological examination. Sedation is performed according to institutional practice [53].…”