Li Xiaoxia, Gichin Changaramkumarath, Xiang Silin, Zhou Ling, Chang Ling
Department of Anesthesiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Medicine (Baltimore). 2020 Oct 2;99(40):e22458. doi: 10.1097/MD.0000000000022458.
Endo-bronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) has been widely accepted as a safe and efficient technique for diagnosing patients with mediastinal/hilar lymphadenopathy and suspected cases of lung cancer. An effective anesthetic technique should provide comfort and quick recovery of patients while allowing the clinicians to obtain adequate tissue sample. Therefore we combined mask ventilation support (SIMV), BIS monitoring, and short-acting medication to achieve the effect mentioned above.
In this report, both patients had lung mass accompanied by cough that lasted for >2 weeks, and were admitted to hospital for further diagnosis and treatment to clarify the nature of the mass. To make a definite diagnosis, EBUS-TBNA examination was performed under general anesthesia. Both patients had no salient past history.
Case 1 was diagnosed as tumor or pneumonia based on the right lung shadow. Case 2 was diagnosed with squamous cell carcinoma of the right lung with right hilar lymph node metastasis. The diagnostic results of both patients were based on pathological examination of tissues obtained by EBUS-TBNA, of which case 1 required further confirmation by lung biopsy.
Both the patients received antibiotic treatment before EBUS-TBNA. We used the mask ventilation supported by SIMV mode without using muscle relaxant, thus providing a guarantee for rapid and high-quality recovery of patients.
During EBUS-TBNA, the vital signs of the 2 patients were stable. Both patients recovered within 5 minutes after we stopped pumping general anesthetics. None of the patient complained of any discomfort and felt comfortable. No complications occurred during and 3 months after EBUS-TBNA examination.
The obtained results showed that this anesthesia scheme can provide appropriate depth of anesthesia for patients undergoing EBUS-TBNA examination, while ensuring rapid and high-quality recovery of patients.
支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）已被广泛认可为诊断纵隔/肺门淋巴结肿大及疑似肺癌患者的一种安全有效的技术。一种有效的麻醉技术应在让临床医生获取足够组织样本的同时，为患者提供舒适感并使其快速恢复。因此，我们将面罩通气支持（同步间歇指令通气）、脑电双频指数（BIS）监测和短效药物相结合以达到上述效果。
在本报告中，两名患者均有肺部肿块并伴有持续超过2周的咳嗽，因进一步诊断和治疗以明确肿块性质而入院。为明确诊断，在全身麻醉下进行了EBUS-TBNA检查。两名患者均无明显既往病史。
病例1根据右肺阴影诊断为肿瘤或肺炎。病例2诊断为右肺鳞状细胞癌伴右肺门淋巴结转移。两名患者的诊断结果均基于EBUS-TBNA获取组织的病理检查，其中病例1需通过肺活检进一步确诊。
两名患者在EBUS-TBNA前均接受了抗生素治疗。我们采用同步间歇指令通气模式支持的面罩通气，未使用肌肉松弛剂，从而为患者快速、高质量恢复提供了保障。
在EBUS-TBNA过程中，两名患者生命体征稳定。停止输注全身麻醉药后，两名患者均在5分钟内恢复。无一例患者抱怨任何不适，感觉舒适。EBUS-TBNA检查期间及检查后3个月均未发生并发症。
所获结果表明，该麻醉方案可为接受EBUS-TBNA检查的患者提供适当的麻醉深度，同时确保患者快速、高质量恢复。
