Szelka-Urbanczyk Anna, Copik Maja, Misiolek Hanna, Olewnicka Ewa, Mirek Maria, Białka Szymon
Department of Anesthesiology and Intensive Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, 41-800 Zabrze, Poland.
J Clin Med. 2025 Mar 14;14(6):1964. doi: 10.3390/jcm14061964.
The evolution of interventional pulmonology has necessitated the refinement of anesthetic techniques to ensure the safety and efficacy of procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), particularly when performed outside the conventional operating room setting. The management of anesthesia in patients with significant comorbidities, classified as American Society of Anesthesiologists (ASA) class III, presents distinct challenges. In this context, the transtracheal block emerges as a viable alternative to total intravenous anesthesia (TIVA) for these high-risk procedures. Objectives: This study aims to evaluate the comparative safety and efficacy of opioid-based intravenous analgesia versus a regimen combining sedative agents with transtracheal block in the administration of anesthesia for EBUS TBNA in high-risk patients. Design: We conducted a randomized observational study involving 57 elective EBUS-TBNA patients classified as ASA class III. Participants were allocated into two cohorts: one receiving intravenous opioid analgesia and the other receiving a combination of sedative agents with transtracheal block. Collected data encompassed patient demographics, medical history, incidence of adverse events during anesthesia, indicators of sympathetic nervous system activation, patient satisfaction levels, and the procedural conditions as assessed by the operator. Opioid anesthesia was associated with increased desaturation (95.7% vs. 60.6%; < 0.05) and higher pain-related sympathetic responses (VAS and SCI at 40-100; < 0.05). No differences in other adverse events, patient satisfaction, or procedural conditions were noted. In summary, the study indicates that transtracheal block combined with sedatives may be a safer anesthetic alternative to opioid-based regimens for high-risk EBUS-TBNA patients, reducing desaturation and pain-related sympathetic activity without affecting satisfaction or procedural efficacy.
介入肺病学的发展使得麻醉技术需要不断完善，以确保诸如支气管内超声引导下经支气管针吸活检术（EBUS-TBNA）等操作的安全性和有效性，尤其是在传统手术室环境之外进行时。对于美国麻醉医师协会（ASA）分级为III级的有严重合并症的患者，麻醉管理面临着独特的挑战。在这种情况下，对于这些高风险操作，经气管阻滞成为全静脉麻醉（TIVA）的一种可行替代方法。目的：本研究旨在评估在高危患者进行EBUS-TBNA麻醉时，基于阿片类药物的静脉镇痛与镇静剂联合经气管阻滞方案的相对安全性和有效性。设计：我们进行了一项随机观察性研究，纳入了57例ASA III级的择期EBUS-TBNA患者。参与者被分为两组：一组接受静脉阿片类镇痛，另一组接受镇静剂联合经气管阻滞。收集的数据包括患者人口统计学、病史、麻醉期间不良事件的发生率、交感神经系统激活指标、患者满意度以及操作者评估的操作条件。阿片类麻醉与更高的低氧饱和度发生率相关（95.7%对60.6%；P<0.05）以及更高的疼痛相关交感反应（40-100时的视觉模拟评分法和交感皮肤反应；P<0.05）。在其他不良事件、患者满意度或操作条件方面未发现差异。总之，该研究表明，对于高危EBUS-TBNA患者，经气管阻滞联合镇静剂可能是比基于阿片类药物方案更安全的麻醉选择，可减少低氧饱和度和疼痛相关的交感活动，而不影响满意度或操作效果。
