Endobronchial Ultrasound under Moderate Sedation versus General Anesthesia

• Main Authors: Maria Gabriela O. Fernandes, Vanessa F. Santos, Natália Martins, Maria C. Sucena, Madalena M. Passos, Maria Manuel Marques, Adriana M. Magalhães, António Bugalho
• Format: Article
• Language: English
• Published: MDPI AG 2018-11-01
• Series: Journal of Clinical Medicine
• Subjects: endobronchial ultrasound; general anesthesia; sedation; diagnosis; staging
• Online Access: https://www.mdpi.com/2077-0383/7/11/421

Background: Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA. Methods: A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators&#8217; difficulties were defined as secondary outcomes. Results: Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 &#177; 1.0 vs. 1.7 &#177; 1.0, <i>p</i> = 0.472) and punctures per station (6.9 &#177; 3.1 vs. 6.0 &#177; 2.5, <i>p</i> = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (<i>p</i> = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties. Conclusions: The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients&#8217; comfort and satisfaction.