BACKGROUND: Transbronchial needle aspiration using endobronchial ultrasonography (EBUS-TBNA), a new minimally invasive diagnostic procedure, has been used to evaluate intrathoracic lymph nodes. It has been reported that EBUS-TBNA can be performed safely under sedation and provides a high level of patient satisfaction. We aimed to describe perianesthetic data, and compare results regarding the agents of subjects undergoing EBUS-TBNA under deep sedation. METHODS: After ethics committee approval, perianesthetic data of 571 subjects undergoing EBUS-TBNA were analyzed retrospectively. Data were collected from anesthesia evaluation and observation forms. Four groups received anesthesia in the operating room as follows: propofol-midazolam (group PM), propofol-ketamine (group PK), propofol-ketamine-midazolam (group PKM), or propofol (group P). Dosage, number of anesthetic injection, hemodynamic variables, recovery time, complications, and patient satisfaction were also recorded. RESULTS: Propofol consumption was higher in groups P and PM compared with groups PK and PKM. Midazolam requirement was higher in group PM than in group PKM. Recovery time was shorter in group P compared with groups PK, PM, and PKM. It was also shorter in groups PK and PM compared with group PKM. All of these differences were statistically significant. Temporary desaturation (n ‫؍‬ 41; 7%) and increased blood pressure (n ‫؍‬ 78; 14%) were predominant complications. In groups PK and PKM, risk of developing hypertension was higher than in groups PM and P (P < .001). The percentage of subjects satisfied with the procedure was 99%. CONCLUSIONS: Independent from the sedative agent, deep sedation can be safe, and provide high patient satisfaction during EBUS-TBNA. The combination of ketamine with propofol or midazolam required lower doses of these anesthetics. However, the incidence of increased blood pressure was higher in groups administered ketamine. Recovery time was the shortest in group P, and the longest in group PKM. There was no relation between recovery time and total dose of anesthetics or presence of chronic disease.

BackgroundThe combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). MethodsFrom January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. Standard anesthesia induction was performed for all patients, and the block was performed in the lateral decubitis position before surgery. Using the in-plane technique, an ultrasound (US)-compatible 22-gauge, 8-mm nerve block needle was introduced 2-3 cm lateral to the spinous process of the T6 vertebra and advanced in the caudocranial direction. Fifteen (15) ml of 0.25% bupivacaine was administered and pleural depression was observed. The same needle was withdrawn from the paravertebral space and advanced into the interfascial plane above the transverse process and below the erector spinae muscle at the T5 level. Then, 15 ml of 0.25% bupivacaine was injected. ResultsThe combination of TPVB and ESPB was performed in 13 patients. The mean age was 44.3 (21-68) years. The mean body mass index (BMI) was 23.21 (16.9-35.9) kg/m 2 . Postoperative 24 hours morphine consumption was 24.5 (16-42) mg. In three cases, visual analog scale (VAS) scores at rest were ≥4; therefore, tramadol (25 mg, IV) was given as an additional analgesic. Nausea and vomiting were observed in only one case in the early postoperative period. ConclusıonsAs a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.

Postoperative efficacy of thoracic epidural analgesia (TEA) following thoracic surgery may vary in patients with different body mass index (BMI) values, regardless of the success of the method. This study aimed to investigate the effects of BMI on postoperative pain scores in patients who underwent thoracotomy with TEA. After obtaining the ethical committee approval (Date: May 11, 2021, Number: 2012-KEAK-15/2305) the data of 1326 patients, who underwent elective thoracic surgery in high volume tertiary thoracic surgery center between January 2017 and January 2021, were analyzed retrospectively. Patients between the age of 18 and 80 years, who underwent thoracotomy and thoracic epidural catheterization (TEC), and who were assigned American Society of Anesthesiologists I to III physical status were included to the study. Of the 406 patients, who underwent a successful TEC, 378 received postoperative analgesia for 72 hours. Visual analog scale (VAS) scores of these patients were evaluated statistically. Based on BMI, patients were categorized into the following 5 groups: Group I: BMI < 20 kg/m 2 , Group II: BMI = 20 to 24.9 kg/m 2 , Group III: BMI = 25 to 29.9 kg/m 2 , Group IV: BMI = 30 to 34.9 kg/m 2 , and Group V: BMI ≥ 35 kg/m 2 . There were no statistically significant differences in TEC success across different BMI groups ( P > .05). Catheter problems and VAS scores significantly increased with higher BMI values in the postoperative 72-hours period ( P < .05). Rates of rescue analgesic use were higher in BMI groups of 30 toto 34.9 kg/m 2 and ≥35 kg/m 2 compared to the other BMI groups. This study revealed that higher BMI in patients may increase VAS scores, who administered TEA for pain management following thoracotomy. This correlation was supported by the increased need for additional analgesics in patients with high BMI. Therefore, patients with high BMI values would require close monitoring and follow-up.

No abstract

EBUS-TBNA may be an initial diagnostic procedure in SCLC. Patients with only hilar/mediastinal masses without any endobronchial lesion could be directed to centers with the capability for performing EBUS-TBNA to have a rapid diagnosis without any time loss.