Evers Georg, Mohr Michael, Sprakel Lena, Galonska Jule, Görlich Dennis, Schulze Arik Bernard
Department of Medicine A, Hematology, Oncology and Pulmonary Medicine, University Hospital Münster, 48149 Münster, Germany.
Institute of Biostatistics and Clinical Research, Westfälische Wilhelms-University Münster, 48149 Münster, Germany.
J Clin Med. 2023 Jun 22;12(13):4223. doi: 10.3390/jcm12134223.
Sedation techniques in interventional flexible bronchoscopy and endobronchial ultrasound-guided transbronchial-needle aspiration (EBUS-TBNA) are inconsistent and the evidence for required general anesthesia under full anesthesiologic involvement is scarce. Moreover, we faced the challenge of providing bronchoscopic care with limited personnel. Hence, we retrospectively identified 513 patients that underwent flexible interventional bronchoscopy and/or EBUS-TBNA out of our institution between January 2020 and August 2022 to evaluate our deep analgosedation approach based on pethidine/meperidine bolus plus continuous flow adjusted propofol, the bronchoscopist-directed continuous flow propofol based analgosedation (BDcfP) in a two-personnel setting. Consequently, 502 out of 513 patients received BDcfP for analgosedation. We identified cardiovascular comorbidities, chronic obstructive pulmonary disease, and arterial hypertension as risk factors for periprocedural hypotension. Propofol flow rate did not correlate with hypotension. Theodrenaline and cafedrine might be used to treat periprocedural hypotension. Moreover, midazolam might be used to support the sedative effect. In conclusion, BDcfP is a safe and feasible sedative approach during interventional flexible bronchoscopy and EBUS-TBNA. In general, after the implementation of safety measures, EBUS-TBNA and interventional flexible bronchoscopy via BDcfP might safely be performed even with limited personnel.
介入性可弯曲支气管镜检查及支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）中的镇静技术并不统一，且在完全麻醉介入下进行全身麻醉的相关证据不足。此外，我们还面临着人员有限却要提供支气管镜护理的挑战。因此，我们回顾性分析了2020年1月至2022年8月期间在我院接受可弯曲介入性支气管镜检查和/或EBUS-TBNA的513例患者，以评估我们基于哌替啶推注加持续输注丙泊酚调整剂量的深度镇痛镇静方法，即在两人操作环境下由支气管镜医师指导的持续输注丙泊酚的镇痛镇静（BDcfP）。结果，513例患者中有502例接受了BDcfP进行镇痛镇静。我们确定心血管合并症、慢性阻塞性肺疾病和动脉高血压是围手术期低血压的危险因素。丙泊酚输注速率与低血压无关。去氧肾上腺素和麻黄碱可用于治疗围手术期低血压。此外，咪达唑仑可用于增强镇静效果。总之，BDcfP是介入性可弯曲支气管镜检查和EBUS-TBNA期间一种安全可行的镇静方法。一般来说，在实施安全措施后，即使人员有限，通过BDcfP进行EBUS-TBNA和介入性可弯曲支气管镜检查也可能是安全的。
