Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration

https://doi.org/10.4081/monaldi.2018.967

Authors

  • Sergio C. Conte | sergio.conte@aulss2.veneto.it Hospital of Vittorio Veneto, Pulmonary Diseases Unit, Italy.
  • Giulia Spagnol University of Trieste, Department of Medical, Surgical and Health Science, Italy.
  • Marco Confalonieri University of Trieste, Department of Medical, Surgical and Health Science, Italy.
  • Beatrice Brizi Azienda ULSS2 Marca Trevigiana, Unit Clinical Research, Italy.

Abstract

The sedation plays an important role in the endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) procedure. The sedation can be Minimal (anxiolysis), Moderate (conscious sedation) or Deep. The ACCP guidelines suggest that moderate or deep sedation (DS) is an acceptable approach. In fact, several studies compare moderate versus deep sedation, but no study has been carried out to compare deep sedation versus minimal. We carried out a retrospective study to compare the Deep versus Minimal sedation (MiS) in patients undergoing EBUS-TBNA.  The primary end point was the diagnostic accuracy. The secondary end points were adequacy and sensitivity. We evaluated the LN size sampling, procedural time, complications and patient tolerance. Thirty-six patients underwent EBUS-TBNA, 16 under DS and 20 under MiS. The overall diagnostic accuracy for correct diagnosis was 92.9% in DS group and 94.1% in MiS group (p=0.554). Sample adequacy, defined as the percentage of patients with a specific diagnosis by EBUS-TBNA, was 87.5% (14 of 16) and 85% (17 of 20) for the DS group and MiS group, respectively, (p=0.788); the sensitivity was 92.9% in the DS group (95% CI, 73-100%) and 92.9% in the MiS group (95% CI, 77-100%) (p=0.463). There were no major complications in either group. Minor complications were 4 in MiS and 1 in DS (p=0.355).  The patients in the MiS group recalled the procedure more often compared to the other group (p=0.041). The majority of the patients would agree to undergo the same procedure again in the future in both groups (p=0.766).  In our experience EBUS-TBNA performed under MiS has comparable accuracy, adequacy, sensitivity, complications and patient satisfaction to DS, even if the sample was small.  Future prospective multicenter studies are needed to confirm our results.

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Published
2018-10-03
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Issue
Section
Pneumology - Original Articles
Keywords:
Endobronchial ultrasound, minimal sedation, deep sedation, diagnostic accuracy, patient satisfaction.
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How to Cite
Conte, Sergio C., Giulia Spagnol, Marco Confalonieri, and Beatrice Brizi. 2018. “Deep Sedation Versus Minimal Sedation During Endobronchial Ultrasound Transbronchial Needle Aspiration”. Monaldi Archives for Chest Disease 88 (3). https://doi.org/10.4081/monaldi.2018.967.