GKD Anest Yoð Bak Dern Derg. 2022; 28(2): 144-152 | DOI: 10.14744/GKDAD.2022.26937

Retrospective Comparison of Conscious Sedation and General Anesthesia in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Umut Kara¹, Deniz Doðan², Mehmet Emin Ýnce¹, Nesrin Öcal², Yakup Arslan², Fatih Þimþek¹, Gökhan Özkan¹, Sami Eksert¹, Mehmet Burak Eþkin¹, Serkan Þenkal¹, Cantürk Taþçý², Ahmet Coþar^1
1Department of Anesthesiology and Reanimation, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Türkiye
²Department of Chest Disease, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Türkiye

Objectives: : The main objective of this study was to evaluate the procedure characteristics and complication rates of ultrasound-guided endobronchial transbronchial needle aspiration (EBUS-TBNA) performed under conscious sedation (CS) versus general anesthesia (GA). The airway devices used for GA were being evaluated as a secondary aim.
Methods: Patients who had EBUS-TBNA at our tertiary hospital’s between January 2017 and December 2021 were retrospectively studied. The study included all participants who were 18 years or older and had no missing medical data. The patients were divided into two groups: Those who had CS and those who had GA. Age, gender, ASA physical status, EBUS-TBNA mean number of lymph node (LN) per patient, and complications during the procedure were compared between groups.
Results: There were 454 patients (58.7%) in the CS group and 319 patients (41.3%) in the GA group in our sample of 773 patients. Classical laryngeal mask airway (LMA) (92.1%) was the most common in the GA group, whereas number 4 LMA (71.7%) was the most preferred in LMA. In EBUS-TBNA, the average number of aspirated LN procedures per patient was greater in the GA group than in the CS group (1.63 vs.1.32). Complications were more common in the CS group than in the GA group (9.7% vs. 4.4%).
Conclusion: The GA approach in EBUS-TBNA was shown to be more successful and safer than the CS approach in terms of number of LNs per patient and complication rates. We also determined that the classic LMA is an appropriate airway device in EBUS-TBNA.

Keywords: Anesthesia, conscious sedation, endobronchial ultrasound, endobronchial ultrasonography, laryngeal mask airway

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Endobronþiyal Ultrason Eþliðinde Transbronþiyal Ýðne Aspirasyonunda (EBUS-TBÝA), Bilinçli Sedasyon ile Genel Anestezinin Retrospektif Karþýlaþtýrýlmasý

Umut Kara¹, Deniz Doðan², Mehmet Emin Ýnce¹, Nesrin Öcal², Yakup Arslan², Fatih Þimþek¹, Gökhan Özkan¹, Sami Eksert¹, Mehmet Burak Eþkin¹, Serkan Þenkal¹, Cantürk Taþçý², Ahmet Coþar^1
1Saðlýk Bilimler Üniversitesi, Gülhane Eðitim ve Araþtýrma Hastanesi, Anesteziyoloji ve Reanimasyon Kliniði, Ankara, Türkiye
²Saðlýk Bilimler Üniversitesi, Gülhane Eðitim ve Araþtýrma Hastanesi, Göðüs Hastalýklarý Kliniði, Ankara, Türkiye

Amaç: Bu çalýþmanýn amacý, bilinçli sedasyon (BS) ile genel anestezi (GA) altýnda uygulanan endobronþiyal ultrason eþliðinde transbronþiyal iðne aspirasyonunda (EBUS-TBÝA) iþlem özellikleri ve komplikasyon oranlarýný karþýlaþtýrmaktýr. Ýkincil amaç ise genel anestezi için kullanýlan hava yolu araçlarýný deðerlendirmektir.
Yöntem: Bu çalýþmada, tersiyer bir hastanenin bronkoskopi merkezinde, Ocak 2017 ile Aralýk 2021 tarihleri arasýnda EBUS-TBÝA yapýlan hastalar retrospektif analiz edildi. On sekiz yaþ ve üstünde olup týbbi verilerinde eksiklik olmayan tüm hastalar çalýþmaya dahil edildi. Hastalar, BS ve GA olmak üzere iki gruba ayrýldý. Gruplar yaþ, cinsiyet, “American Society of Anesthesiologist (ASA)” fiziksel statü, EBUS-TBÝA, hasta baþýna düþen aspire lenf nodu iþlem sayýsý ortalamasý ve iþlem sýrasýndaki komplikasyonlar açýsýndan karþýlaþtýrýldý.
Bulgular: Çalýþmadaki 773 hastanýn 454’ü (%58,7) BS grubunda, 319’u (%41,3) GA grubundaydý. GA grubunda en sýk klasik laringeal mask airway (LMA) (%92,1); LMA içinde de en sýk 4 numara LMA (%71,7) kullanýldý. BS grubunda 308 (%68) hastaya midazolam, 146 (%32) hastaya midazolam+fentanil kombinasyonu uygulandý. EBUS-TBÝA’da hasta baþýna düþen aspire edilen lenf nodu iþlem sayýsý ortalamasý; GA grubunda BS grubuna göre daha yüksek bulundu (1,63’e karþý 1,32). BS grubunda, GA grubuna göre (%9,7’ye karþý %4,4) daha sýk komplikasyon görüldü.
Sonuç: EBUS-TBÝA’da GA'nýn; hasta baþýna düþen lenf nodu sayýsý ve komplikasyon oranlarý açýsýndan, BS'ye göre daha etkili ve güvenli; klasik LMA’nýn da uygun bir hava yolu aracý olduðu gösterildi.

Anahtar Kelimeler: Anestezi, bilinçli sedasyon, endobronþiyal ultrasonografi, laringeal mask airway

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