Agostini Lorenzo, Facciolongo Nicola, Lusuardi Mirco, Casalini Eleonora, Galeone Carla, Lasagni Luciano, Zucchi Luigi
Azienda Ospedaliera ASMN-Istituto di Ricovero e Cura a Carattere Scientifico.
Monaldi Arch Chest Dis. 2017 Jul 18;87(2):768. doi: 10.4081/monaldi.2017.768.
Endobronchial Ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is usually performed under general anesthesia or deep sedation with drugs such as Propofol that, at least in Italy, can be administered only by an anesthesiologist. Aim of the study was to assess conscious sedation feasibility, safety and tolerability using Meperidine and Midazolam as administered by Pulmonologist and relevant impact on the efficiency of the sampling procedures.All patients undergoing EBUS-TBNA from February 2013 to July 2014 were examined retrospectively. Efficiency using Meperidine and Midazolam during EBUS-TBNA has been assessed: completion of lymph-nodal sampling, sampling adequacy, diagnostic yield, cough during endoscopic procedure complications and need for procedure repetition with Anesthesiology assistance. Patient satisfaction and cost/effectiveness were also evaluated. One hundred and thirty-four consecutive patients were considered; 97.7% completed the procedure. In 96.9% of cases the prefixed program of lymph-nodal sampling was accomplished. Sampling adequacy was 92,4%. Diagnostic yield was 55%. In 94.7% of cases cough was absent or did not interfere with EBUS-TBNA. The need to repeat the endoscopic procedure occurred in 6 cases but only in 2 the presence of an Anesthesiologist was required. Patient satisfaction was very high, with 95.9% of subjects reporting they would "definitely return". A 27% cost reduction was calculated. EBUS-TBNA under conscious sedation using Meperidine and Midazolam prescribed and administered by pulmonologist without the Anesthesiologist assistance, revealed to be a safe, well tolerated and cost saving procedure. The efficiency of sampling was good, apart from a relatively low diagnostic yield due to different expertise of operators.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）通常在全身麻醉或使用丙泊酚等药物进行深度镇静的情况下进行，至少在意大利，这些药物只能由麻醉医生给药。本研究的目的是评估由肺科医生使用哌替啶和咪达唑仑进行清醒镇静的可行性、安全性和耐受性，以及对采样程序效率的相关影响。对2013年2月至2014年7月期间接受EBUS-TBNA的所有患者进行了回顾性检查。评估了在EBUS-TBNA期间使用哌替啶和咪达唑仑的效率：淋巴结采样的完成情况、采样充分性、诊断率、内镜检查过程中的咳嗽并发症以及在麻醉科协助下重复手术的必要性。还评估了患者满意度和成本效益。连续纳入134例患者；97.7%完成了手术。在96.9%的病例中完成了预定的淋巴结采样计划。采样充分率为92.4%。诊断率为55%。在94.7%的病例中没有咳嗽或咳嗽未干扰EBUS-TBNA。有6例需要重复内镜手术，但只有2例需要麻醉医生在场。患者满意度非常高，95.9%的受试者表示他们“肯定会再来”。计算出成本降低了27%。由肺科医生在无麻醉医生协助的情况下开具和使用哌替啶和咪达唑仑进行清醒镇静下的EBUS-TBNA，被证明是一种安全、耐受性良好且节省成本的手术。除了由于操作者专业水平不同导致诊断率相对较低外，采样效率良好。
