Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration

Abstract

The sedation plays an important role in the endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) procedure. The sedation can be Minimal (anxiolysis), Moderate (conscious sedation) or Deep. The ACCP guidelines suggest that moderate or deep sedation (DS) is an acceptable approach. In fact, several studies compare moderate versus deep sedation, but no study has been carried out to compare deep sedation versus minimal. We carried out a retrospective study to compare the Deep versus Minimal sedation (MiS) in patients undergoing EBUS-TBNA. The primary end point was the diagnostic accuracy. The secondary end points were adequacy and sensitivity. We evaluated the LN size sampling, procedural time, complications and patient tolerance. Thirty-six patients underwent EBUS-TBNA, 16 under DS and 20 under MiS. The overall diagnostic accuracy for correct diagnosis was 92.9% in DS group and 94.1% in MiS group (p=0.554). Sample adequacy, defined as the percentage of patients with a specific diagnosis by EBUS-TBNA, was 87.5% (14 of 16) and 85% (17 of 20) for the DS group and MiS group, respectively, (p=0.788); the sensitivity was 92.9% in the DS group (95% CI, 73-100%) and 92.9% in the MiS group (95% CI, 77-100%) (p=0.463). There were no major complications in either group. Minor complications were 4 in MiS and 1 in DS (p=0.355). The patients in the MiS group recalled the procedure more often compared to the other group (p=0.041). The majority of the patients would agree to undergo the same procedure again in the future in both groups (p=0.766). In our experience EBUS-TBNA performed under MiS has comparable accuracy, adequacy, sensitivity, complications and patient satisfaction to DS, even if the sample was small. Future prospective multicenter studies are needed to confirm our results.

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

“…All but one retrospective studies reported that diagnostic yield and patient tolerance under deep propofol sedation was equivalent to that under moderate midazolam sedation [37][38][39][40]. Prospective randomized control trials comparing the use of propofol for general anesthesia and midazolam for moderate sedation were also comparable in terms of diagnostic yield, major complications, and patient tolerance [31,41].…”

A retrospective study of endobronchial ultrasound transbronchial needle aspiration versus conventional transbronchial needle aspiration in diagnosis/staging of hilar/mediastinal lymph node in lung cancer: Which role in clinical practice?

“…Finally, we showed that the type of sedation did not influence our results. In fact, several studies showed that the type of sedation does not influence the diagnostic yield, sensitivity and accuracy [26][27][28].…”

Safety of geriatric patients undergoing endobronchial ultrasound-guided transbronchial needle aspiration with deep sedation: a retrospective study

“…It is used to evaluate mediastinal and hilar lymph nodes and effectively determine the stage of lung cancer [ 1 – 6 ]. It is also recommended to diagnose suspected cases of lymphoma, sarcoidosis, and tuberculosis [ 2 , 5 – 8 ].…”

“…While FOB can be performed routinely only under mild sedation or local anesthesia, EBUS-TBNA can be performed in a wide range from minimal sedation to general anesthesia [ 5 – 13 ]. Ideal sedation for EBUS-TBNA is aimed to increase diagnostic efficiency, prevent complications, and improve patient comfort by providing adequate procedural tolerance [ 3 , 7 , 8 , 13 – 16 ]. The choice of sedation type varies according to institutional resources and approaches.…”