Assessment of perianesthesic data in subjects undergoing endobronchial ultrasound-guided transbronchial needle aspiration

• Published in: Respiratory care 2015-04, Vol.60 (4), p.567-576
• Main Authors: Sazak, Hilal, Tunç, Mehtap, Alagöz, Ali, Pehlivanoğlu, Polat, Demirci, Nilgün Yılmaz, Alıcı, İbrahim O, Yılmaz, Aydın
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anesthesia; Anesthesia Recovery Period; Anesthetics, Intravenous - administration & dosage; Blood Pressure - drug effects; Bronchoscopy - methods; Conscious Sedation - methods; Drug Therapy, Combination; Endoscopic Ultrasound-Guided Fine Needle Aspiration - methods; Female; Humans; Ketamine - administration & dosage; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Male; Medical ultrasonics; Methods; Midazolam - administration & dosage; Middle Aged; Needle biopsy; Patient Satisfaction; Propofol - administration & dosage; Retrospective Studies; Thoracic Diseases - diagnostic imaging; Thoracic Diseases - pathology
• ISSN: 0020-1324; 1943-3654
• DOI: 10.4187/respcare.03547

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. 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. 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%. 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.