Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration
Deep sedation versus minimal sedation during endobronchial ultrasound transbronchial needle aspiration
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DOI：
10.4081/monaldi.2018.967
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发表时间：
2018-01-01
影响因子：
1.9
通讯作者：
Brizi, Beatrice
中科院分区：
文献类型：
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作者：
Conte, Sergio C.;Spagnol, Giulia;Brizi, Beatrice
镇静在支气管内超声经支气管针吸活检（EBUS-TBNA）过程中起着重要作用。镇静可以是轻微（抗焦虑）、中度（清醒镇静）或深度。ACCP指南建议中度或深度镇静（DS）是一种可接受的方法。事实上，有几项研究比较了中度与深度镇静，但没有研究比较深度镇静与最小镇静。我们进行了一项回顾性研究，以比较接受EBUS-TBNA的患者的深度与最小镇静（MiS）。主要终点是诊断准确性。次要终点是充分性和敏感性。我们评估了LN大小、取样、手术时间、并发症和患者耐受性。36例患者接受EBUS-TBNA，16例接受DS，20例接受MiS。DS组和MiS组正确诊断的总体诊断准确率分别为92.9%和94.1%（p=0.554）。样本充足性，定义为EBUS-TBNA特异性诊断的患者百分比，为87.5%（14/16）和85% DS组和MiS组分别为（17/20），（p=0.788）; DS组的敏感性为92.9%（95% CI，73-100%），MiS组为92.9%（95% CI，77-100%）（p=0.463）。两组均无严重并发症。MiS组有4例轻微并发症，DS组有1例轻微并发症（p=0.355）。MiS组患者回忆手术的频率高于其他组（p=0.041）。两组中的大多数患者同意在未来再次接受相同的手术（p=0.766）。根据我们的经验，在MiS下进行的EBUS-TBNA具有与DS相当的准确性、充分性、灵敏度、并发症和患者满意度，即使样本量很小。未来的前瞻性多中心研究需要证实我们的结果。
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.