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Correspondence |

Use of Fentanyl and Safety of Endobronchial UltrasoundSafety of Endobronchial Ultrasound FREE TO VIEW

Andrew R. L. Medford, MD, FCCP
Author and Funding Information

From the North Bristol Lung Centre, Southmead Hospital.

Correspondence to: Andrew R. L. Medford, MD, FCCP, North Bristol Lung Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, England; e-mail: andrewmedford@hotmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(3):1083. doi:10.1378/chest.13-1027
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To the Editor:

A recent issue of CHEST (April 2013) highlights an important issue pertaining to the safety of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In the issue, Çoruh et al1 report on an adverse effect of fentanyl used for bronchoscopy and EBUS-TBNA. We have calculated the mean dose in our institution administered for conscious sedation for EBUS-TBNA to be 3.4 mg midazolam and 62.5 μg fentanyl (or 0.9 μg/kg) with good patient tolerability.2 This compares to one-fourth of the dose of fentanyl used in the reported case, and perhaps the dose difference would account for the observed adverse reaction. There are likely to be organizational factors that also influence the mean dosage of conscious sedatives used. For example, in many institutions, an anesthetist may not be present in the endoscopy suite, and, therefore, lower levels of sedation may be used without the use of a laryngeal mask or endotracheal tube.3 It is also customary in such institutions using milder conscious sedation to avoid giving sedative reversal agents if possible. Indeed, in some cases of EBUS-TBNA it is possible to achieve reasonable sedation and patient tolerability with only 1 mg midazolam and no fentanyl or other agents, which is of particular value in patients with poor lung function in whom an esophageal approach with endoscopic ultrasound bronchoscope-guided fine needle aspiration4,5 is not possible as an alternative.

In summary, it is important to be aware of potential adverse effects of fentanyl and other agents used in EBUS-TBNA conscious sedation. In our experience, such events are best avoided by minimizing the dose of the drug used without sacrificing patient tolerability of the procedure.

References

Çoruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013;143(4):1145-1146. [CrossRef] [PubMed]
 
Jeyabalan A, Lockman H, Medford AR. Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under mild conscious sedation [abstract]. Thorax. 2012;67(suppl 2):A94. [CrossRef]
 
Medford AR, Agrawal S, Free CM, Bennett JA. A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM. 2009;102(12):859-864. [CrossRef] [PubMed]
 
Medford AR, Agrawal S. Single bronchoscope combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration for tuberculous mediastinal nodes. Chest. 2010;138(5):1274. [CrossRef] [PubMed]
 
Medford AR. Endoscopic ultrasound bronchoscope-guided fine needle aspiration (EUS-B-FNA). Thoracic Cancer. 2013;4(1):90. [CrossRef]
 

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References

Çoruh B, Tonelli MR, Park DR. Fentanyl-induced chest wall rigidity. Chest. 2013;143(4):1145-1146. [CrossRef] [PubMed]
 
Jeyabalan A, Lockman H, Medford AR. Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under mild conscious sedation [abstract]. Thorax. 2012;67(suppl 2):A94. [CrossRef]
 
Medford AR, Agrawal S, Free CM, Bennett JA. A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM. 2009;102(12):859-864. [CrossRef] [PubMed]
 
Medford AR, Agrawal S. Single bronchoscope combined endoscopic-endobronchial ultrasound-guided fine-needle aspiration for tuberculous mediastinal nodes. Chest. 2010;138(5):1274. [CrossRef] [PubMed]
 
Medford AR. Endoscopic ultrasound bronchoscope-guided fine needle aspiration (EUS-B-FNA). Thoracic Cancer. 2013;4(1):90. [CrossRef]
 
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