title: The effect of general anesthesia versus intravenous sedation on diagnostic yield and success in electromagnetic navigation bronchoscopy.
abstract: BACKGROUND
  Navigational bronchoscopy is utilized to guide biopsies of peripheral lung nodules and place fiducial markers for treatment of limited stage lung cancer with stereotactic body radiotherapy. The type of sedation used for this procedure remains controversial. We performed a retrospective chart review to evaluate the differences of diagnostic yield and overall success of the procedure based on anesthesia type.
  
  
  METHODS
  Electromagnetic navigational bronchoscopy was performed using the superDimension software system. Once the targeted lesion was within reach, multiple tissue samples were obtained. Statistical analysis was used to correlate the yield with the type of sedation among other factors. A successful procedure was defined if a diagnosis was made or a fiducial marker was adequately placed.
  
  
  RESULTS
  Navigational bronchoscopy was performed on a total of 120 targeted lesions. The overall complication rate of the procedure was 4.1%. The diagnostic yield and success of the procedure was 74% and 87%, respectively. Duration of the procedure was the only significant difference between the general anesthesia and IV sedation groups (mean, 58 vs. 43 min, P=0.0005). A larger tumor size was associated with a higher diagnostic yield (P=0.032). All other variables in terms of effect on diagnostic yield and an unsuccessful procedure did not meet statistical significance.
  
  
  CONCLUSIONS
  Navigational bronchoscopy is a safe and effective pulmonary diagnostic tool with relatively low complication rate. The diagnostic yield and overall success of the procedure does not seem to be affected by the type of sedation used.
authors.affiliation: *Department of Internal Medicine, Division of Pulmonary Critical Care and Sleep Medicine, Brody School of Medicine, East Carolina University †East Carolina Heart Institute at East Carolina University ‡Leo W. Jenkins Cancer Center, East Carolina University School of Medicine §Department of Public Health ∥Division of Cardiovascular and Thoracic Surgery, East Carolina Heart Institute at East Carolina University, Greenville, NC.
authors.forename: Mark R
authors.initials: MR
authors.lastname: Bowling
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Kohan
authors.forename: Paul
authors.initials: P
authors.lastname: Walker
authors.forename: Jimmy
authors.initials: J
authors.lastname: Efird
authors.forename: Sharon
authors.initials: S
authors.lastname: Ben Or
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000009:adverse effects / Q000379:methods*; D001706:Biopsy; D001999:Bronchoscopy / Q000379:methods*; D055590:Electromagnetic Phenomena; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012984:Software