The role of sedation in endobronchial ultrasound-guided transbronchial needle aspiration: Systematic review

Aswanetmanee, Pantaree; Limsuwat, Chok; Kabach, Mohamad; Alraiyes, Abdul Hamid; Kheir, Fayez

doi:10.4103/2303-9027.191608

Cited by 37 publications

(13 citation statements)

References 27 publications

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“…While our study was not powered to assess this outcome, our data suggest that conscious sedation is similar to general anaesthesia in terms of diagnostic accuracy, including EBUS TBNA from a wide range of nodal stations. This is in keeping with several recent trials assessing this question [ 15 , 16 , 20 – 23 ].…”

Section: Discussionsupporting

confidence: 89%

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

et al. 2021

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BackgroundThe difference in patient comfort with conscious sedation (CS) versus general anaesthesia (GA) for bronchoscopy has not been adequately assessed in a randomised trial. This study aimed to assess if patient comfort during bronchoscopy with CS is non-inferior to GA.Methods96 subjects were randomized to receive CS or GA for bronchoscopy. The primary outcome was subject comfort. Secondary outcomes included: Willingness to undergo a repeat procedure if necessary andlevel of sedation assessed clinically and by Bispectral Index (BIS) monitoring.ResultsThere was no significant difference between subject comfort scores (difference −0.01 (95% CI −0.63, 0.61 on a 10 point scale,, p=0.97) or willingness to undergo a repeat procedure (97.7% versus 91.8%, (95% CI −4.8%, 15.5%); p=0.37). Deeper levels of sedation in the GA cohort was confirmed with both clinical and BIS. There was no significant difference in diagnostic accuracy (CS: 93.9% (95% CI 80.4%, 98.3%) versus GA: 86.5% (95% CI 72.0%, 94.1%); p=0.43). There were more complications (29.6% (95% CI 18.2%, 44.2%) versus 6.1% (95% CI 2.1%, 16.5%); p<0.01) in the GA group. There was no relationship between high BIS scores and subject discomfort. BIS levels of less than 40 during a procedure was associated with increased complications.ConclusionCS is not inferior to GA in providing patient comfort during bronchoscopy despite lighter sedation and is associated with fewer complications and comparable diagnostic accuracy. BIS monitoring may have a role in preventing complications associated with deeper sedation.

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Section: Discussionsupporting

confidence: 89%

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

et al. 2021

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“…Yarmish et al showed higher diagnostic yeld in the deep sedation group when compared to moderate sedation in a retrospective study [31]. A systematic review of five studies including that of Yarmish et al concluded that moderate and deep sedation used for EBUS-TBNA procedures have comparable diagnostic yields [32].…”

Section: Discussionmentioning

confidence: 99%

A pragmatic application of endobronchial ultrasound-guided transbronchial needle aspiration: a single institution experience

et al. 2019

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Background Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) is minimally invasive technique used for diagnosis and/or staging of benign and malignant pulmonary and non-pulmonary disease. Previous studies have established the utility of EBUS-TBNA in narrowly defined indications and populations. In this pragmatic ‘real world’ study we have analysed the use of EBUS-TBNA for a variety of clinical presentations and its clinical application in conjunction with other invasive investigations. Methods All EBUS-TBNA procedures performed at Sir Charles Gardiner Hospital in 2012–2014 were reviewed retrospectively, using relevant hospital databases. Results A total of 327 patients underwent 337 EBUS-TBNA procedures. EBUS-TBNA procedures were used to diagnose a wide spectrum of benign and malignant conditions. The main application was in the diagnosis and staging of malignant conditions (70.6%), and in the diagnosis of benign conditions such as sarcoidosis 40 (12.2%), and silicoanthracosis 17 (5.2%). EBUS-TBNA was sufficient to diagnose and stage the disease as a single stand-alone invasive procedure in 191 (59.2%) patients. EBUS-TBNA was the final invasive procedure undertaken in 283 (87.6%) patients. Only 13.3% of non small cell lung cancer (NSCLC) patients who had EBUS-TBNA as a first investigation required multiple procedures compared to 51.1% of all NSCLC patients undergoing EBUS-TBNA. Overall sensitivity, specificity, NPV and diagnostic accuracy for EBUS-TBNA were 89.7, 100, 85.1 and 89.9%, respectively and three minor complications (0.9%) occurred as a result of the procedure. Conclusions EBUS-TBNA was undertaken for a wide variety of clinical conditions. Good diagnostic accuracy and safety profiles were demonstrated for the procedure, supporting its application as a first line investigation in the diagnosis and/or staging of a range of malignant and benign conditions. Our study was unique in its documentation of the use of EBUS-TBNA in a real-world setting in conjunction with other invasive modalities. EBUS-TBNA was utilised as a stand alone invasive procedure in more than half of the patients. Importantly, in NSCLC, when EBUS-TBNA was performed as primary diagnostic and staging investigation, less patients underwent subsequent invasive procedures.

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“…In accordance with previous studies, the diagnostic yield of EBUS-TBNA, defined as the number of individuals in whom EBUS-TBNA provided a specific diagnosis, was determined. [49] Samples of lymph nodes were considered adequate when lymphocytes were present or when rendering a specific diagnosis whereas biopsies of lung masses were only considered as adequate when rendering a specific diagnosis. [4]…”

Section: Methodsmentioning

confidence: 99%

Endobronchial ultrasound-guided transbronchial needle aspiration under general anesthesia versus bronchoscopist-directed deep sedation: A retrospective analysis

et al. 2019

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Background: Different sedation strategies are used during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the diagnostic workup of lung cancer including general anesthesia (GA) and moderate sedation. However, no data are available about EBUS-TBNA under deep sedation (DS) with fiberoptic intubation directed by the investigator. Materials and Methods: A retrospective analysis of EBUS-TBNAs under GA ( n = 160) or DS ( n = 105) was performed. Results: Unadjusted diagnostic yield did not differ significantly between the groups (GA: 42.5% vs. DS: 53.3%; P = 0.1018). Similar results were obtained when only patients with a final diagnosis of malignancy were analyzed (GA: 53.6% vs. DS: 61.5%; P = 0.2675). Adverse events (AEs) occurred more often under DS (GA: 27.5% vs. DS: 59.1%; P < 0.0001) due to more sedation-related problems whereas severe AEs tended to be higher under GA (GA: 7.5% vs. DS: 1.9%; P = 0.0523). Conclusion: In summary, our data show that the diagnostic yield and the complication rate of EBUS-TBNA performed under DS are similar compared to GA. Hence, in an appropriate setting, EBUS-TBNA can be performed safely under DS.

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The role of sedation in endobronchial ultrasound-guided transbronchial needle aspiration: Systematic review

Cited by 37 publications

References 27 publications

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

A randomised study of comfort during bronchoscopy comparing conscious sedation and anaesthetist-controlled general anaesthesia, including the utility of bispectral index monitoring

A pragmatic application of endobronchial ultrasound-guided transbronchial needle aspiration: a single institution experience

Endobronchial ultrasound-guided transbronchial needle aspiration under general anesthesia versus bronchoscopist-directed deep sedation: A retrospective analysis

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