Douadi Y, Bentayeb H, Malinowski S, Hoguet E, Lecuyer E, Boutemy M, Lachkar S, Fournier C, Dayen C
Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, 02100 Saint-Quentin, France.
Rev Mal Respir. 2010;27(1):37-41. doi: 10.1016/j.rmr.2009.11.004. Epub 2009 Dec 5.
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used.
Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment. Historically, anaesthesiologists have applied the expertise gained in managing anaesthesia for major surgery to sedation care for minor procedures. While the supply of anaesthesiologists and anaesthetists has shown only a modest increase, the growth in minimally invasive procedures has been exponential in recent years. To investigate this further, we performed a retrospective study of the use of general anaesthetic with ventilation by a laryngeal mask during EBUS, which we have adopted in our unit.
Sixty-three patients were included in the study. In 41 a laryngeal mask was used and in 22 the examination was performed under local anaesthetic alone. Eighty-seven percent of procedures were informative with cells from lymph nodes obtained (89% from examinations using laryngeal mask with a mean of 3.8 passes and 86% with sedation alone with a mean of 2.9 passes). In 45 cases (78%) it was possible to avoid mediastinoscopy.
It was possible to establish a secure airway and maintain oxygenation with the laryngeal mask during bronchoscopy without any reduction in the success of the procedure.
最近研究表明，支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）在纵隔淋巴结转移的诊断和分期方面是一种准确的方法。该操作比传统支气管镜检查耗时显著更长，因此可能会引起更多不适。自其在法国引入呼吸科实践以来，已经采用了多种气道管理策略。
麻醉护理和程序镇静服务的共同目标是，在可能令人痛苦的操作过程中为患者提供舒适感，同时确保手术医生拥有可接受的工作环境。从历史上看，麻醉医生已将在大型手术麻醉管理中积累的专业知识应用于小型手术的镇静护理。虽然麻醉医生的数量仅略有增加，但近年来微创手术的增长呈指数级。为了进一步研究这一情况，我们对在EBUS期间使用喉罩通气的全身麻醉的应用进行了回顾性研究，这是我们科室所采用的方法。
63例患者纳入研究。41例使用喉罩，22例仅在局部麻醉下进行检查。87%的操作获得了有诊断价值的淋巴结细胞（使用喉罩检查的患者中89%获得了有诊断价值的细胞，平均穿刺3.8次；仅使用镇静剂的患者中86%获得了有诊断价值的细胞，平均穿刺2.9次）。45例（78%）患者避免了纵隔镜检查。
在支气管镜检查期间使用喉罩能够建立安全气道并维持氧合，且不降低操作的成功率。
