Sedation with propofol and remifentanil for real-time endobronchial ultrasound needle aspiration

  • Esther Vila Anesthesia Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Anna Mases Anesthesia Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Enrique Vela Anesthesia Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Luis Molto Anesthesia Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Albert Sanchez-Font Pulmonology Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Víctor Curull Pulmonology Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
  • Lluis Gallart Anesthesia Service, Parc de Salut Mar, Institut de Recerca Hospital del Mar (IMIM), Universitat Autònoma de Barcelona, Spain
Keywords: Endosonography, Propofol, Anesthesia, Bronchoscopy

Abstract

Introduction: Optimal linear endobronchial ultrasound (EBUS) outcomes require sedation to ensure that the patient remains calm, immobile, and does not cough, and so that the bronchoscopist can work comfortably. The choice of anesthesia techniques, on a spectrum ranging from general anesthesia to sedation, is not standardized. The aims of this study were to determine doses, safety and satisfaction for intravenous sedation with propofol and remifentanil, and identify potential predictors of coughing during the procedure, and determine patient and bronchoscopist satisfaction with the procedure.

Patients and methods: The prospective study included patients undergoing EBUS under sedation in a tertiary hospital.

Results: A total of 90 patients underwent EBUS under sedation with remifentanil and propofol, at infusion rates of 0.13 (0.09-0.17) |xgkg-1min-1 and 2.34 (1.5-3.6) mg kg-1 h-1, respectively. Just over four fifths of the patients (81%) coughed at some point during the ultrasound procedure. In 8% of patients the procedure was promptly discontinued due to coughing and desaturation. There were no major complications directly related to sedation. Bronchoscopists and patients rated their satisfaction with the procedure as excellent or good in most cases. There was no statistically significant relationship between the number of coughing episodes during the procedure and any of the following variables: positive cough test, a habitual cough, tobacco dependence, or severity of chronic obstructive pulmonary disease.

Conclusions: Remifentaml and propofol administered by an anesthesiologist enabled spontaneously breathing patients to undergo linear EBUS, although with a high incidence of coughing and particularly desaturation. No predictors for coughing during EBUS were identified.

References

1. Garcia-Olive I, Valverde Forcada X, Andreo Garcia F, Sanz-Santos J, Castella E, Llatjos M, et al. Linear endobronchial ultrasound as the initial diagnostic tool in patients with indications of mediastinal disease. Arch Bronconeumol. 2009;45:266-70.

2. Gottlieb K, Wallace MB. Estadificación del cáncer de pulmón mediante punción aspirativa con aguja fina guiada por ultrasonografía endoscópica y endobronquial. Arch Bronconeumol. 2009;45:603-10.

3. Omark Petersen H, Eckardt J, Hakami A, Olsen KE, Jorgensen OD. The value of mediastinal staging with endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer. Eur J Cardiothorac Surg. 2009;36:465-8.

4. Adams K, Shah PL, Edmonds L, Lim E. Test performance of endobronchial ultrasound and transbronchial needle aspiration biopsy for mediastinal staging in patients with lung cancer: systematic review and meta-analysis. Thorax. 2009;64:757-62.

5. Herth FJ, Eberhardt R, Vilmann P, Krasnik M, Ernst A. Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes. Thorax. 2006;61:795-8.

6. Herth FJ, Ernst A, Eberhardt R, Vilmann P, Dienemann H, Krasnik M. Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically normal mediastinum. Eur Respir J. 2006;28:910-4.

7. Herth FJ, Rabe KF, Gasparini S, Annema JT. Transbronchial and transoesophageal (ultrasound-guided) needle aspirations for the analysis of mediastinal lesions. Eur Respir J. 2006;28:1264-75.

8. Yasufuku K, Chiyo M, Sekine Y, Chhajed PN, Shibuya K, Iizasa T, et al. Real-time endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal and hilar lymph nodes. Chest. 2004;126:122-8.

9. Cameron SE, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology 21:6-26.

10. Sarkiss M, Kennedy M, Riedel B, Norman P, Morice R, Jimenez C, et al. Anesthesia technique for endobronchial ultrasound-guided fine needle aspiration of mediastinal lymph node. J Cardiothorac Vasc Anesth. 2007;21:892-6.

11. Slonim A, Ognibene F. Enhancing patient safety for pediatric bronchoscopy: alternatives to conscious sedation. Chest. 2001;120:341-2.

12. Monsó E, Andreo Garcia F, Rosell A, Cuellar P, Castella E, Llatjos M. Utilidad de la ultrasonografía endobronquial con punción-aspiración en tiempo real para la estadificación de la neoplasia broncopulmonar. Med Clin (Barc). 2007;128:481-5.

13. McAlister FA, Bertsch K, Man J, Bradley J, Jacka M. Incidence of and risk factors for pulmonary complications after non thoracic surgery. Am J Respir Crit Care Med. 2005;171: 514-7.

14. From the Global Strategy for the Diagnosis MaPoC. Global Initiative for Chronic Obstructive Lung Disease (GOLD); 2010. Available from: http://www.goldcopd.org

15. Pauwels RABA, Calverley PM, Jenkins CR, Hurd SS, GOLD Scientific Committee. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) workshop summary. Am J Respir Crit Care Med. 2001;163:1256-76.

16. Wahidi MM, Jain P, Jantz M, Lee P, Mackensen GB, Barbour SY, et al. American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients. Chest. 2011;140:1342-50.

17. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001;56 Suppl. 1:i1-21.

18. Pickles J, Jeffrey M, Datta A. Is preparation for bronchoscopy optimal? Eur Respir J. 2003;22:203-6.

19. Dreher M, Ekkernkamp E, Storre JH, Kabitz HJ, Windisch W. Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: midazolam versus midazolam plus alfentanil. Respiration. 2010;79:307-14.

20. Gonzalez R, De-La-Rosa-Ramirez I, Maldonado-Hernandez A, Dominguez-Cherit G. Should patients undergoing a bronchoscopy be sedated? Acta Anaesthesiol Scand. 2003;47:411-5.

21. Atassi K, Mangiapan G, Fuhrman C, Lasry S, Onody P, Housset B. Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients: a randomized, controlled, double-blind trial. Chest. 2005;128:863-8.

22. Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995;89:53-6.

23. Tsunezuka Y, Sato H, Tsukioka T, Nakamura Y, Watanabe Y. The role of codeine phosphate premedication in fibre-optic bronchoscopy under insufficient local anaesthesia and midazolam sedation. Respir Med. 1999;93:413-5.

24. Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax. 2004;59:773-6.

25. Jantz M. The old and the new in sedation for bronchoscopy. Chest. 2009;135:4-6.

26. Fauroux B, Onody P, Gall O. The efficacy of premixed nitrous oxide and oxygen for fiberoptic bronchoscopy in pediatric patients: a randomized, double-blind, controlled study. Chest. 2004;125:315-21.
27. Schwarz Y, Greif J, Lurie O, Tarrasch R, Weinbroum AA. Dextromethorphan premedication reduces midazolam requirements: objective and subjective parameters in peribronchoscopy. Respiration. 2006;74:314-9.

28. Chhajed PN, Wallner J, Stolz D. Sedative drug requirements during flexible bronchoscopy. Respiration. 2005;72:617-21.

29. Lechtzin N, Rubin H, White PJ, Jenckes M, Diette G. Patient satisfaction with bronchoscopy. Am J Respir Crit Care Med. 2002;166:1326-31.

30. Sánchez-Font A, Curull V, Vollmer I, Pijuan L, Gayete A, Gea J. Utilidad de la punción aspirativa transbronquial guiada con ultrasonografía endobronquial (USEB) radial para el diagnóstico de adenopatías mediastínicas. Arch Bronconeumol. 2009;45:212-7.
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Vila E, Mases A, Vela E, Molto L, Sanchez-Font A, Curull V, Gallart L. Sedation with propofol and remifentanil for real-time endobronchial ultrasound needle aspiration. Colomb. J. Anesthesiol. [Internet]. 2013Apr.1 [cited 2021Apr.23];41(2):120-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/877

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2013-04-01
How to Cite
1.
Vila E, Mases A, Vela E, Molto L, Sanchez-Font A, Curull V, Gallart L. Sedation with propofol and remifentanil for real-time endobronchial ultrasound needle aspiration. Colomb. J. Anesthesiol. [Internet]. 2013Apr.1 [cited 2021Apr.23];41(2):120-6. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/877
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