• 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, and Hans J Lee.
• Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 7125M, Baltimore, MD 21287, USA. lyarmus@jhmi.edu
• Ann Am Thorac Soc. 2013 Apr 1;10(2):121-6.

RationaleMost 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.ObjectivesTo compare the impact of moderate versus deep sedation on the adequacy and diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).MethodsA retrospective 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 ResultsNo 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).ConclusionsDiagnostic 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.

25 keywords...

hide…