title: Comparison of moderate versus deep sedation for endobronchial ultrasound transbronchial needle aspiration.
abstract: BACKGROUND
  Most bronchoscopic procedures are performed using moderate sedation achieved by combining a short-acting benzodiazepine with an opioid agent. Propofol (2.6-diisopropylphenol), a short-acting hypnotic agent, has been increasingly used to provide deep sedation in the endoscopy community with an acceptable safety profile.
  
  
  OBJECTIVE
  To compare the impact of moderate versus deep sedation on the adequacy and diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).
  
  
  METHODS
  A retrospective review of prospectively collected data was performed at two academic institutions with interventional pulmonary fellowships using two methods of sedation during EBUS (deep vs. moderate sedation). Rapid on-site cytologic evaluation was used on all procedures in both groups. EBUS-TBNA nodal sampling was considered adequate if the aspirate yielded a specific diagnosis or lymphocytes. EBUS-TBNA was considered diagnostic if a lymph node aspirate yielded a specific diagnosis or if subsequent surgical sampling or prolonged radiographic surveillance revealed no nodal pathology.
  
  
  RESULTS
  No difference was observed in the indication for EBUS-TBNA between the two groups. More lymph nodes were sampled per patient in the deep sedation group (314 nodes from 163 patients; 2.2 nodes per patient) than in the moderate sedation group (181 lymph nodes from 146 patients; 1.4 nodes per patient; P < 0.01). The EBUS-TBNA diagnostic yield was higher for the deep sedation group (80% of patients) than for the moderate sedation group (66% of patients; P < 0.01).
  
  
  CONCLUSIONS
  Diagnostic yield and number of lymph nodes sampled using deep sedation is superior to moderate sedation in patients undergoing EBUS-TBNA. Prospective studies accounting for other factors including patient selection and cost are needed.
authors.affiliation: Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Suite 7125M, Baltimore, MD 21287, USA. lyarmus@jhmi.edu
authors.forename: Lonny B
authors.initials: LB
authors.lastname: Yarmus
authors.forename: Jason A
authors.initials: JA
authors.lastname: Akulian
authors.forename: Christopher
authors.initials: C
authors.lastname: Gilbert
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Mathai
authors.forename: Srividya
authors.initials: S
authors.lastname: Sathiyamoorthy
authors.forename: Sarina
authors.initials: S
authors.lastname: Sahetya
authors.forename: Kassem
authors.initials: K
authors.lastname: Harris
authors.forename: Colin
authors.initials: C
authors.lastname: Gillespie
authors.forename: Andrew
authors.initials: A
authors.lastname: Haas
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.forename: Daniel
authors.initials: D
authors.lastname: Sterman
authors.forename: Hans J
authors.initials: HJ
authors.lastname: Lee
mesh_terms: D001707:Biopsy, Needle / Q000379:methods*; D001999:Bronchoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000379:methods*; D054810:Deep Sedation / Q000379:methods*; D019160:Endosonography; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging / Q000473:pathology; D008482:Mediastinum; D015203:Reproducibility of Results; D012189:Retrospective Studies