title: Advanced diagnostic bronchoscopy using conscious sedation and the laryngeal nerve block: tolerability, thoroughness, and diagnostic yield.
abstract: OBJECTIVE
  Although bronchoscopy has conventionally been performed using conscious sedation, advanced diagnostic techniques like endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), peripheral EBUS, and electromagnetic navigational bronchoscopy add to procedural complexity. The adaptation of these techniques by bronchoscopists of varied backgrounds is expanding. It is not clear how patients will tolerate these advanced procedures when they are performed using traditional conscious sedation.
  
  
  METHODS
  We prospectively studied patients that underwent diagnostic bronchoscopic procedures using conscious sedation over a 1-year period. The primary outcome was patient tolerability measured with four questions soliciting subjective responses. Secondary outcomes included required dosage of medications, thoroughness of the procedure, diagnostic yield, and occurrence of complications.
  
  
  RESULTS
  A total of 181 patients were enrolled. Compared to patients in whom conventional bronchoscopy with transbronchial biopsies were performed, there was no difference in patient tolerability using the advanced techniques. Although some of the advanced procedures added to the procedure time, the required amount of medication was within commonly accepted dosages. When EBUS-TBNA was performed, a mean of 2.8 lymph node stations per patient were sampled. A specific diagnosis was obtained in 55.9 % of patients who solely underwent EBUS-TBNA. The diagnostic yield increased to 75.7 % when a parenchymal abnormality prompted additional biopsies. One patient required sedation reversal. Complications were minimal.
  
  
  CONCLUSIONS
  This study suggests that advanced diagnostic bronchoscopic procedures are well tolerated using conscious sedation with no compromise of thoroughness, diagnostic yield, or safety. This may be useful for bronchoscopists using these techniques who do not have ready access to general anesthesia.
authors: Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 15 York Street, LCI 100, New Haven, CT, 06510, USA.
authors: Geetinder
authors: G
authors: Goyal
authors: Margaret A
authors: MA
authors: Pisani
authors: Terrence E
authors: TE
authors: Murphy
authors: Katy L
authors: KL
authors: Araujo
authors: Jonathan T
authors: JT
authors: Puchalski
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D015331:Cohort Studies; D016292:Procedural Sedation / Q000379:methods*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods; D005260:Female; D006801:Humans; D007823:Laryngeal Nerves; D008171:Lung Diseases / Q000175:diagnosis; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D061214:Patient Safety; D011446:Prospective Studies; D011786:Quality Control; D012680:Sensitivity and Specificity