[Anaesthesia for bronchial echoendoscopy: experience with the laryngeal mask].
BACKGROUND
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used.


METHODS
Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment. Historically, anaesthesiologists have applied the expertise gained in managing anaesthesia for major surgery to sedation care for minor procedures. While the supply of anaesthesiologists and anaesthetists has shown only a modest increase, the growth in minimally invasive procedures has been exponential in recent years. To investigate this further, we performed a retrospective study of the use of general anaesthetic with ventilation by a laryngeal mask during EBUS, which we have adopted in our unit.


RESULTS
Sixty-three patients were included in the study. In 41 a laryngeal mask was used and in 22 the examination was performed under local anaesthetic alone. Eighty-seven percent of procedures were informative with cells from lymph nodes obtained (89% from examinations using laryngeal mask with a mean of 3.8 passes and 86% with sedation alone with a mean of 2.9 passes). In 45 cases (78%) it was possible to avoid mediastinoscopy.


CONCLUSIONS
It was possible to establish a secure airway and maintain oxygenation with the laryngeal mask during bronchoscopy without any reduction in the success of the procedure.
Service de pneumologie, maladies infectieuses et tropicales, centre hospitalier de Saint-Quentin, 1, avenue Michel-de-l'Hospital, 02100 Saint-Quentin, France. ydou@club-internet.fr <ydou@club-internet.fr>
Y
Y
Douadi
H
H
Bentayeb
S
S
Malinowski
E
E
Hoguet
E
E
Lecuyer
M
M
Boutemy
S
S
Lachkar
C
C
Fournier
C
C
Dayen
D000368:Aged; D000768:Anesthesia, General; D000772:Anesthesia, Local; D001707:Biopsy, Needle; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D017214:Laryngeal Masks; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology*; D008297:Male; D008479:Mediastinal Neoplasms / Q000473:pathology* / Q000556:secondary*; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D013996:Time and Motion Studies; D018084:Ultrasonography, Interventional