Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam

Abstract

Background: According to the guidelines, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the technique of choice for the diagnosis of mediastinal involvement in lung cancer; it is also useful for other mediastinal malignancies and benign pathology. Nevertheless, there is still discussion about whether to perform it under general anesthesia or under conscious sedation. Methods: We retrospectively analyzed the data of all patients who underwent EBUS-TBNA under conscious sedation with up to 1 mg/kg of meperidine and up to 0.15 mg/kg of midazolam in the Interventional Pulmonology Unit of the Azienda USL-IRCCS Santa Maria Nuova of Reggio Emilia during 2 consecutive years. Demographic data, indication for the procedure, duration, number of lymph node sampled, number of passes per station, diagnostic yield, drugs dosage, questionnaire score, and complications were collected. Results: A total of 302 patients underwent EBUS-TBNA, and 68% of the patients were males and the mean age was 65 AE 13 years old. The average duration of procedures was 24.4 minutes and the mean dosage of drugs was 4.32 AE 1.52 mg for midazolam and 50.86 AE 13.71 mg for meperidine. The mean number of lymph nodes sampled per patient was 1.75 AE 0.82, and each patient received an average of 4.71 AE 1.78 passes. A total of 90.7% of patients completed the procedures, 85% had adequate samples, and 94.4% of patients declared with Likert's questionnaire that they strongly agree to repeat the test if necessary. Conclusion: EBUS-TBNA performed under conscious sedation with meperidine and midazolam is feasible and well-tolerated and has a similar diagnostic yield of that reported in literature.

Clinical application of endoscopic ultrasonography-guided transbronchial needle aspiration biopsy ---A single center, large sample, real-world study

“…For the higher sensitivity of TBNA in the diagnosis of lung cancer, totally the diagnosis sensitivity was 70.2% of male patients, and 62.9% of female patients. Previous studies also showed that there were little higher percent of males than females that underwent TBNA [19][20][21] . There was few study compared the diagnostic value of EBUS-TBNA between male and female patients.…”

“…Anesthesia is very important to protect the patients to tolerate the operation of EBUS-TBNA [13,14,20] . In this study, the anesthesia method was mainly general intravenous anesthesia with spontaneous breathing, which was safe with little trauma of the patient and caused less adverse effects.…”

“…Most of the patients can tolerate the operation well, even in elder patients that more than 80 years old [21][22][23] . The operation can also be completed by mild anesthesia of sedation and analgesia with the patients awake, which is suitable for some patients with poor cardiopulmonary function or who cannot tolerate deep anesthesia [20] . There was an interesting trends in this study that more and more patients anesthetized by general intravenous anesthesia with spontaneous breathing (more than 90% since 2017), and less patients anesthetized by deep general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation follow the years, which consisted with the results reported in previous study that EBUS-TBNA performed under conscious sedation with meperidine and midazolam is feasible and well-tolerated and has a good diagnostic yield [20] .…”

“…The operation can also be completed by mild anesthesia of sedation and analgesia with the patients awake, which is suitable for some patients with poor cardiopulmonary function or who cannot tolerate deep anesthesia [20] . There was an interesting trends in this study that more and more patients anesthetized by general intravenous anesthesia with spontaneous breathing (more than 90% since 2017), and less patients anesthetized by deep general anesthesia of intravenous and inhalation with tracheal intubation and mechanical ventilation follow the years, which consisted with the results reported in previous study that EBUS-TBNA performed under conscious sedation with meperidine and midazolam is feasible and well-tolerated and has a good diagnostic yield [20] . There were few limitations of this study, rst, in this retrospective study, clinical application of EBUS-TBNA in the diagnosis of different diseases were described, we need some prospectively comparisons of the diagnostic yield of EBUS-TBNA in different diseases; Second, the different positive rate between male and female patients may be caused by different proportions of patients with different diseases, and case-control study or paired comparisons should be performed; Third, more concern should be paid on the complications of EBUS-TBNA.…”

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

“…Studies in recent years report a comparable diagnostic yield of 55–99.5% in procedures performed under moderate sedation and a yield of 77.6–93% in procedures performed under general anesthesia. The incidence of adverse events in procedures performed under both modalities of periprocedural sedation is also similar [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ].On the other hand, there have not been many studies comparing the diagnostic yield of RP-EBUS-TBNAs performed under general anesthesia versus moderate sedation.…”