Öztaş Selahattin, Aka Aktürk Ülkü, Alpay Levent A, Meydan Burhan, Ogün Hamza, Taylan Mahşuk, Yalçınsoy Murat, Çalışır Haluk C, Görgüner Ali Metin, Ernam Dilek
Chest Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
Thoracic Surgery Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
Clin Respir J. 2017 Nov;11(6):935-941. doi: 10.1111/crj.12442. Epub 2016 Feb 24.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure.
Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups.
The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed.
Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）是一种用于评估胸内淋巴结的新型微创支气管镜技术。各中心在该手术前使用镇静药物的情况有所不同。EBUS-TBNA术前镇静尚无标准化方案。我们在一家大型三级医院采用政策决定，从使用丙泊酚联合咪达唑仑改为单独使用咪达唑仑，以评估EBUS-TBNA手术的诊断率和安全性。
对2010年9月至2014年5月期间接受EBUS-TBNA的所有患者的病历进行调查。所有EBUS-TBNA病例最初均在丙泊酚和咪达唑仑镇静下由麻醉医生陪同进行，然而，由于镇静政策的改变，2013年4月后仅使用咪达唑仑且无麻醉医生陪同。通过卡方分析比较两组的诊断率和并发症发生率。
评估了340例行EBUS-TBNA患者的病历。对其中274例符合条件的患者进行分析。丙泊酚-咪达唑仑（P）镇静组分析了152例符合纳入标准的患者，咪达唑仑（M）组分析了122例患者。两个不同镇静组在年龄和性别方面无统计学显著差异。P组诊断价值为77.6%，M组为85.7%，差异无统计学意义。两组并发症发生率无差异。
在我们的研究中，两种用于EBUS-TBNA的镇静方式显示出相似的诊断价值和并发症发生率。丙泊酚联合咪达唑仑的应用需要麻醉医生陪同，因此增加了成本。在中度镇静下，EBUS-TBNA手术安全进行，诊断率无下降。
