Comparison of moderate versus deep sedation for endobronchial ultrasound transbronchial needle aspiration

Lonny B. Yarmus, Jason A. Akulian, Christopher Gilbert, Stephen C. Mathai, Srividya Sathiyamoorthy, Sarina Sahetya, Kassem Harris, Colin Gillespie, Andrew Haas, David Feller-Kopman, Daniel Sterman, Hans J. Lee

Research output: Contribution to journalReview articlepeer-review

Abstract

Rationale: Most bronchoscopic procedures are performed using moderate sedation achieved by combining a short-acting benzodiazepine with an opioid agent. Propofol (2.6- diisopropylphenol), a short-acting hypnotic agent, has been increasingly used to provide deep sedation in the endoscopy community with an acceptable safety profile. Objectives: To compare the impact of moderate versus deep sedation on the adequacy and diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Methods: Aretrospective review of prospectively collected data was performed at two academic institutions with interventional pulmonary fellowships using two methods of sedation during EBUS (deep vs. moderate sedation). Rapid on-site cytologic evaluation was used on all procedures in both groups. EBUS-TBNA nodal sampling was considered adequate if the aspirate yielded a specific diagnosis or lymphocytes. EBUS-TBNA was considered diagnostic if a lymph node aspirate yielded a specific diagnosis or if subsequent surgical sampling or prolonged radiographic surveillance revealed no nodal pathology. Measurements and Main Results: No difference was observed in the indication for EBUS-TBNA between the two groups. More lymph nodes were sampled per patient in the deep sedation group (314 nodes from 163 patients; 2.2 nodes per patient) than in the moderate sedation group (181 lymph nodes from 146 patients; 1.4 nodes per patient; P < 0.01). The EBUS-TBNA diagnostic yield was higher for the deep sedation group (80% of patients) than for the moderate sedation group (66% of patients; P < 0.01). Conclusions: Diagnostic yield and number of lymph nodes sampled using deep sedation is superior to moderate sedation in patients undergoing EBUS-TBNA. Prospective studies accounting for other factors including patient selection and cost are needed.

Original languageEnglish (US)
Pages (from-to)121-126
Number of pages6
JournalAnnals of the American Thoracic Society
Volume10
Issue number2
DOIs
StatePublished - Apr 2013

Keywords

  • Endobronchial ultrasound
  • Interventional pulmonology
  • TBNA

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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