Accuracy and feasibility of electromagnetic navigated bronchoscopy under nitrous oxide sedation for pulmonary peripheral opacities: an outpatient study.
BACKGROUND
Recent studies have described the promising method of electromagnetic navigated bronchoscopy (ENB) for diagnosis of peripheral solitary nodules. However, they require general anaesthesia or intravenous sedation. We wanted to know if ENB could be applied more easily in outpatients.


OBJECTIVE
We prospectively evaluated the accuracy and the feasibility of ENB under local anaesthesia and nitrous oxide/oxygen inhalation as unique sedation in outpatients.


METHODS
After mapping time, the bronchoscopic procedure was carried out under local anaesthesia and nitrous oxide/oxygen inhalation with the unique help of the ENB to confirm the right position of the extended working channel before sampling. The primary end point was the accuracy of ENB and the secondary end point was the feasibility in outpatients.


RESULTS
Among 54 screened patients, 53 completed the study protocol. The overall diagnostic success rate to diagnose malignancy was 71.4% in tumours of 28 mm in median size. ENB classified correctly peripheral lesions according to malignity in 41 cases (30 cases of cancer, 11 benign diagnosis) and failed in 12 cases (1 probable lung metastasis, 11 lung cancers). All patients but 1 were dismissed 1 h after the procedure and the tolerance of the procedure was excellent in all cases except 2 (agitation and anxiety). In two cases (4%) a pneumothorax was recorded, 1 requiring drainage with a chest tube during a short hospitalisation.


CONCLUSIONS
ENB under nitrous oxide/oxygen sedation seems to be an accurate and safe procedure. In our series, it allowed us to obtain the diagnosis in 71.4% of the tumours, with a good tolerance and an outpatient strategy.
Bertoletti
Laurent
L
Department of Chest Diseases and Thoracic Oncology, Hôpital Nord, University Hospital of St Etienne, Saint-Etienne, France.
Robert
Aurélie
A
Cottier
Michèle
M
Chambonniere
Marie Laure
ML
Vergnon
Jean-Michel
JM
D000368:Aged; D018685:Anesthetics, Inhalation; D001999:Bronchoscopy / Q000379:methods*; D003951:Diagnostic Errors; D004574:Electromagnetic Fields; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D009609:Nitrous Oxide; D011014:Pneumonia / Q000175:diagnosis; D011446:Prospective Studies; D011658:Pulmonary Fibrosis / Q000175:diagnosis
D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide