Pulmonary Procedures |

Pharmacological Conscious Sedation Techniques in Endobronchial Ultrasonography: An Observational Analysis of Five Models and Complications Associated FREE TO VIEW

Juan Pablo Reig, MBBS; Estafanía Sanchez, MBBS; Susana Álvarez, MBBS; Andrés Briones, MD; Felipe Andreo, MD; Javier Flandes, MD; Enrique Cases Viedma, MD
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Hospital La Fe, Valencia, Spain

Chest. 2014;145(3_MeetingAbstracts):489A. doi:10.1378/chest.1776314
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SESSION TITLE: Bronchoscopy and Interventional Procedures Posters

SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: Endobronchial Ultrasonography (EBUS) is an important tool in the diagnosis and staging of lung cancer, and in the study of mediastinal lymph nodes. A conscious sedation method is needed to improve the tolerance and increase its yield. The aim of this study was to analyze five different pharmacological sedation models and to establish the safest drug combination.

METHODS: An observational multicenter study was performed including 246 patients who undergo EBUS with conscious sedation. The sedation level was controlled by the endoscopist or by an anesthetist, both assisted by nurses. The sedation drug schemes were: A) intravenous bolus of Midazolam (n=23), B) perfusion of Propofol (n=35), C) bolus of midazolam and perfusion of propofol (n=87), D) remifentanil and propofol both in perfusion (n=28), E) intravenous bolus of midazolam and propofol (n=75). Vital signs and transcutaneous pCO2 were monitored at the beginning and every ten minutes. Consciousness level was controlled by Bi-spectral Index (BIS) or Visual Sedation Scale (VSS). Indications and complications were recorded.

RESULTS: We analyzed 246 EBUS, 190 males and 58 females (mean ages 63 and 59). The duration average was 44’23 minutes. The models B and D were controlled by anesthetist and models A, C and E by the endoscopist. The clinical reasons to undertake the EBUS were: lymphadenopathy study (n=126), staging of lung cancer (n=84), mediastinal or hiliar mass study (n=31). The most frequent complication was hypotension (10’9%) followed by cough (9’3%) and hypertension (8’4%). Model D has associated the highest rate of complications. Complications were resolved in the Endoscopy Unit with non invasive therapeutic actions.

CONCLUSIONS: Intravenous bolus of midazolam and propofol was the pharmacological model whit the lowest rate of complications associated. In this study remiphentanil, used by anesthetist, has associated the higher rate of complications. The complications can be resolved with simple therapeutic actions.

CLINICAL IMPLICATIONS: The sedation can be controlled and complications can easily be treated by a trained endoscopist.

DISCLOSURE: The following authors have nothing to disclose: Juan Pablo Reig, Estafanía Sanchez, Susana Álvarez, Andrés Briones, Felipe Andreo, Javier Flandes, Enrique Cases Viedma

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