Fouad Algyar Mohammad, Torky Mohamed, Mohamed Ibrahim Ahmed, Abdelbadie Mohamed, A Almohasseb Mhmoud, Ahmed Moharam Saad, Abdelraheem Taysser
Anesthesiology, Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
Chest Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
Anesth Pain Med. 2024 Jul 10;14(3):e146646. doi: 10.5812/aapm-146646. eCollection 2024 Jun.
One of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the level of sedation.
Therefore, we aimed to compare dexmedetomidine (DEX) as moderate sedation (MS) versus general anesthesia (GA) on the diagnostic yield of EBUS-TBNA.
This randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as American Society of Anesthesiologists (ASA) II or III, and scheduled for EBUS-TBNA. Patients were randomly allocated into two equal groups. Group D received 1 μg/kg fentanyl 2 minutes before induction with a 1 μg/kg infusion of DEX for 10 minutes, then maintenance with 0.5 - 1 μg/kg/h aiming for a Ramsey Sedation Scale of 4 - 5 while preserving hemodynamics. Group GA received 1 μg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes).
Group D had a significantly higher rate of recalling the procedure (P = 0.005) and a lower rate of shortness of breath compared to group GA (P = 0.038). Intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group D compared to group GA (P < 0.05). Intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. Recovery time was significantly shorter in group D compared to group GA (P < 0.001).
Compared to GA, MS with DEX showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in EBUS-TBNA.
影响支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）诊断率的因素之一是镇静水平。
因此，我们旨在比较右美托咪定（DEX）作为中度镇静（MS）与全身麻醉（GA）对EBUS-TBNA诊断率的影响。
这项随机开放标签对照试验纳入了70例18岁以上、美国麻醉医师协会（ASA）分级为II或III级且计划行EBUS-TBNA的患者。患者被随机分为两组。D组在诱导前2分钟给予1μg/kg芬太尼，随后以1μg/kg的剂量输注DEX 10分钟，然后以0.5 - 1μg/kg/h的速度维持输注，目标是使Ramsey镇静评分达到4 - 5级，同时维持血流动力学稳定。GA组给予1μg/kg芬太尼、2mg/kg丙泊酚和0.5mg/kg阿曲库铵（然后每20分钟给予0.1mg/kg）。
与GA组相比，D组对操作过程的回忆率显著更高（P = 0.005），呼吸急促发生率更低（P = 0.038）。两组基线时的术中心率测量值无显著差异，但与GA组相比，D组在5分钟、10分钟、15分钟、20分钟及手术结束时的心率显著更低（P < 0.05）。两组在基线、5分钟、10分钟、15分钟、20分钟及手术结束时的术中平均动脉血压测量值无显著差异。与GA组相比，D组的恢复时间显著更短（P < 0.001）。
与GA相比，DEX用于MS时在EBUS-TBNA中的诊断率相当，恢复时间更快，患者满意度更高，这体现在患者愿意在需要时重复该操作以及呼吸急促症状较少。
