Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam. Issue 4 (7th January 2022)

• Record Type: Journal Article
• Authors: Piro, Roberto; Casalini, Eleonora; Fontana, Matteo; Galeone, Carla; Ruggiero, Patrizia; Taddei, Sofia; Ghidoni, Giulia; Patricelli, Giulia; Facciolongo, Nicola
• Is Part Of: Thoracic cancer. Volume 13:Issue 4(2022)
• Page Start: 533
• Page End: 538
• Publication Date: 2022-01-07
• Subjects: bronchoscopy -- EBUS‐TBNA -- meperidine -- midazolam -- sedation; Chest -- Cancer -- Periodicals; Chest -- Cancer -- Treatment -- Periodicals; Chest -- Surgery -- Periodicals; 616.99494005
• DOI: 10.1111/1759-7714.14286
• Languages: English
• ISSNs: 1759-7706

Abstract

Abstract: Background: According to the guidelines, endobronchial ultrasound guided transbronchial needle aspiration (EBUS‐TBNA) is the technique of choice for the diagnosis of mediastinal involvement in lung cancer; it is also useful for other mediastinal malignancies and benign pathology. Nevertheless, there is still discussion about whether to perform it under general anesthesia or under conscious sedation. Methods: We retrospectively analyzed the data of all patients who underwent EBUS‐TBNA under conscious sedation with up to 1 mg/kg of meperidine and up to 0.15 mg/kg of midazolam in the Interventional Pulmonology Unit of the Azienda USL‐IRCCS Santa Maria Nuova of Reggio Emilia during 2 consecutive years. Demographic data, indication for the procedure, duration, number of lymph node sampled, number of passes per station, diagnostic yield, drugs dosage, questionnaire score, and complications were collected. Results: A total of 302 patients underwent EBUS‐TBNA, and 68% of the patients were males and the mean age was 65 ± 13 years old. The average duration of procedures was 24.4 minutes and the mean dosage of drugs was 4.32 ± 1.52 mg for midazolam and 50.86 ± 13.71 mg for meperidine. The mean number of lymph nodes sampled per patient was 1.75 ± 0.82, and each patient received an average of 4.71 ± 1.78 passes. A total of 90.7% of patients completed the procedures, 85% had adequate samples, and 94.4% of patients declared with Likert's questionnaire that they strongly agree to repeat the test if necessary. Conclusion: EBUS‐TBNA performed under conscious sedation with meperidine and midazolam is feasible and well‐tolerated and has a similar diagnostic yield of that reported in literature. Abstract : In this study involving 302 patients, EBUS‐TBNA performed under conscious sedation with meperidine and midazolam led to 85% exams with adequate samples, of whom 62% were diagnostic and 38% showed normal lymph node tissue. A total of 12% were inadequate and 3% of scheduled exams were not performed. Severe and persistent adverse events have not been observed. A total of 94.4% of patients declared that they strongly agree to repeat the exam if necessary.