Effectiveness and safety of local anesthetic, semi-flexible pleuroscopy – experience from a peripheral hospital

Abstract

If the seemingly less invasive semi-flexible pleuroscopes are combined with strategies of conscious sedation and local anesthesia the pleuroscopy has the potential to reach an increasing number of hospital settings. Local experiences can provide valuable information pertaining to the reproducibility of this technique in different scenarios. We performed a retrospective analysis of the clinical records of all patients that had undergone local anesthetic semi-flexible pleuroscopy in our unit between February 2015 and July 2017. Data on demographics, previous biochemical, cytological and histopathological analysis, procedure details, diagnostic and therapeutic results, complications and mortality were collected from all patients. Statistical analysis was performed using SPSS v23. A total of 30 patients were included. They were mainly male (66.7%), with a median age of 72 years (minimum 19 years, maximum 87 years). All presented with exudative pleural effusions and the exam was performed for diagnostic reasons. Pleural tissue was obtained in all patients and the overall diagnostic accuracy was 93.3%. Malignancy was the chief group of diagnosis (66.7%), followed by pleural tuberculosis (13.3%). The procedure was well tolerated and self-limited subcutaneous emphysema was the only complication registered (13.3%). No deaths were associated with the procedure. Our results globally overlap those of wider series and reinforce the perception that local anesthetic semi-flexible pleuroscopy is a well-tolerated, safe and highly accurate diagnostic and therapeutic tool which has proved to be both feasible and effective in our experience.

Comparison of the Efficacy and Safety of Thoracoscopy under Local Anesthesia in Patients Aged over and under 75 Years: A Single-center Experience

“…No serious adverse events were observed during or after thoracoscopy, indicating a relatively high safety profile. It is comparable to reports from a Portuguese hospital similar to ours and maintains a high level of safety 15) . It should be noted that the present study shows that >80% of patients suffer from hypoxemia, requiring oxygenation in the perioperative period.…”

Review of the Physiology and Anesthetic Considerations for Pleuroscopy/Medical Thoracoscopy

“…Despite several studies reporting on the safety of midazolam in pleuroscopy, none of them was designed to closely examine the safety and efficacy of PSA during the procedure. Rather, they concentrated more on the overall intervention-related outcomes, safety, and diagnostic outcomes [70][71][72][73][74].…”