Impact of different sedation modalities on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

Ciriaco, Paola

doi:10.21037/med-20-22

Cited by 6 publications

(12 citation statements)

References 18 publications

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“…It has been reported that desaturations during bronchoscopy are temporary and do not require any special treatment other than oxygen support. [18] This study has several limitations. We had to rely on patient records for intraoperative hemodynamic data, sedation scores, and side effects.…”

Section: Discussionmentioning

confidence: 92%

Transbronchial Needle Aspiration under the guidance of Endobronchial Ultrasound in Lung Cancer Diagnosis; Retrospective Evaluation of Anesthesia Methods

Kaya¹

2022

Lokman Hekim Health Sci

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Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure in diagnosing and staging lung cancer. Anesthesia management is one of the critical steps in the EBUS-TBNA procedures. We planned to evaluate anesthesia methods for EBUS-TBNA, which was applied for the first time in our hospital, in terms of duration of the procedure and complications. Methods: The records of patients who underwent EBUS-TBNA after ethics committee approval were reviewed retrospectively. We recorded demographic data of the patients, duration of the procedure, anesthesia methods, and complications. Results: A total of 50 patients were given anesthesia for the EBUS-TBNA. General anesthesia was performed in 5 patients and sedation in 45 patients.The duration of anesthesia was 62±17.8 min ingeneral anesthesiaand 50.2±13.1 min in sedated patients (p=0.113). Ketamine/propofol (ketofol) was used in 22 patients, and propofol/fentanyl was used in 23 patients for sedation. The amount of propofol was significantly higher in those using propofol/fentanyl than ketofol (propofol/fentanyl: 342.2±140 mg, ketofol: 166.5±49.9 mg; p=0.002).There was no significant difference in the frequency of postoperative complications. Discussion and Conclusion: The choice of anesthesia method for EBUS procedures should be adjusted according to factors associated with the operator, the patient, and the procedure itself. We think sedation can be used safely in EBUS procedures with good preliminary preparation, intraoperative management, and anesthesiologist-bronchoscopist compatibility.

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Section: Discussionmentioning

confidence: 92%

Transbronchial Needle Aspiration under the guidance of Endobronchial Ultrasound in Lung Cancer Diagnosis; Retrospective Evaluation of Anesthesia Methods

Kaya¹

2022

Lokman Hekim Health Sci

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“…As endoscopic ultrasound procedures become more widely employed around the world, there is an increased interest in the most ideal modality for periprocedural sedation. It is a balance between resource availability, cost consideration, bronchoscopist preference, patients’ comfort, and diagnostic yield [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Yield and Safety of CP-EBUS-TBNA and RP-EBUS-TBLB under Moderate Sedation: A Single-Center Retrospective Audit

et al. 2022

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Convex probe endobronchial ultrasound transbronchial needle aspirations (CP-EBUS-TBNAs) and radial probe endobronchial ultrasound transbronchial lung biopsies (RP-EBUS-TBLBs) can be performed under moderate sedation or general anesthesia. Moderate sedation is more convenient, however patient discomfort may result in inadequate tissue sampling. General anesthesia ensures better patient cooperation but requires more logistics and also carries sedation risks. We aim to describe the diagnostic yield and safety of CP-EBUS-TBNAs and RP-EBUS-TBLBs when performed under moderate sedation at our center. All patients who underwent CP-EBUS-TBNA and/or RP-EBUS-TBLB under moderate sedation, between January 2015 and May 2017, were reviewed. Primary outcomes were defined in regard to the diagnostic yield and safety profile. A total of 336 CP-EBUS-TBNAs and 190 RP-EBUS-TBLBs were performed between January 2015 and May 2017. The mean sedation doses used were 50 mcg of intravenous fentanyl and 2.5 mg of intravenous midazolam. The diagnostic yield of the CP-EBUS-TBNAs and RP-EBUS-TBLBs were 62.5% and 71.6%, respectively. Complication rates were low with: transient bleeding 11.9%, transient hypoxia 0.5%, and pneumothorax 0.1%. None required escalation of care, post procedure. Performing CP-EBUS-TBNAs and RP-EBUS-TBLBs under moderate sedation is safe and provides good diagnostic yield. These procedures should, therefore, be considered as first-line sampling techniques.

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“…Since the process is generally lengthy, unpleasant, and extremely irritating to the airway, it is preferably conducted under sedation [ 3 , 4 ]. Previous research has indicated that deep sedation increases diagnostic yield and the amount of lymph nodes examined compared to moderate sedation [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Esketamine Combined with Propofol TCI versus Propofol TCI for Deep Sedation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Prospective, Randomized, and Controlled Trial

Cui,

Huang,

Wei

et al. 2023

International Journal of Clinical Practice

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Background. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an invasive procedure that required deep sedation to suppress coughing and body movements. Deep sedation, on the other hand, has been shown to cause respiratory and circulatory depression, especially when the airway is shared with the endoscopist. Esketamine is a novel sedative and analgesic with little respiratory inhibition that appears to be an appropriate adjuvant in propofol sedation for EBUS-TBNA. We compared the efficacy and safety of esketamine combined with propofol target-controlled infusion (TCI) and propofol TCI for deep sedation in EBUS-TBNA. Methods. The study included 135 patients with ASA II-III undergoing EBUS-TBNA. They were randomly divided into two groups (group E and group P). Both groups received midazolam (0.01–0.03 mg/kg) and oxycodone (0.07–0.08 mg/kg). Then, patients in group E received 0.3 mg/kg esketamine, propofol TCI, and 0.2 mg·kg−1·h−1 esketamine for sedative maintenance. Patients in group P received only propofol TCI. The primary outcome was the dose of 1% lidocaine administrated by the endoscopist and the times of lidocaine sprays. Secondary outcome indicators were cough score, propofol dosage, patient satisfaction, endoscopist satisfaction, the incidence of sedation-related adverse effects and side effects, and recovery time. Results. Patients in group E were given significantly less lidocaine (4.36 ml/h (2.67–6.00) vs 6.00 ml/h (4.36–7.20), P < 0.001 ) and less spraying frequency (2.18 times/h (1.33–3.00) vs 3.00 times/h (2.18–3.60), P < 0.001 ) than group P. There was a statistically significant difference in cough score between the two groups (group E 2 (0–4) vs group P 3 (2–4), P = 0.03 ). Also, mean arterial pressure (MAP) was higher in group E in the 30th min (T5, 84.10 ± 12.91 mmHg versus 79.04 ± 10.01 mmHg, P = 0.012 ) and 40th min (T6, 87.72 ± 15.55 mmHg versus 82.14 ± 10.51 mmHg, P = 0.026 ). There were no significant differences between the two groups in terms of sedation-related adverse events and side effects, recovery time, endoscopist satisfaction, and patient satisfaction. Conclusions. In patients with ASA II-III, esketamine as an adjuvant in combination with propofol TCI deep sedation for EBUS-TBNA can improve the sedation effect, reduce coughing reaction during the procedure, and obtain more stable blood pressure. No reduction in the occurrence of sedation-related side effects was observed. This trial is registered with ChiCTR2200061124.

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Impact of different sedation modalities on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

Cited by 6 publications

References 18 publications

Transbronchial Needle Aspiration under the guidance of Endobronchial Ultrasound in Lung Cancer Diagnosis; Retrospective Evaluation of Anesthesia Methods

Transbronchial Needle Aspiration under the guidance of Endobronchial Ultrasound in Lung Cancer Diagnosis; Retrospective Evaluation of Anesthesia Methods

Diagnostic Yield and Safety of CP-EBUS-TBNA and RP-EBUS-TBLB under Moderate Sedation: A Single-Center Retrospective Audit

Esketamine Combined with Propofol TCI versus Propofol TCI for Deep Sedation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Prospective, Randomized, and Controlled Trial

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