title: A comparison of propofol-midazolam and midazolam alone for sedation in endobronchial ultrasound-guided transbronchial needle aspiration: a retrospective cohort study.
abstract: OBJECTIVE
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure.
  
  
  METHODS
  Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups.
  
  
  RESULTS
  The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed.
  
  
  CONCLUSIONS
  Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.
authors.affiliation: Chest Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Selahattin
authors.initials: S
authors.lastname: Öztaş
authors.affiliation: Chest Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Ülkü
authors.initials: Ü
authors.lastname: Aka Aktürk
authors.affiliation: Thoracic Surgery Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Levent A
authors.initials: LA
authors.lastname: Alpay
authors.affiliation: Anestesiology Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Meydan
authors.affiliation: Chest Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Hamza
authors.initials: H
authors.lastname: Ogün
authors.affiliation: Chest Department, Dicle University, Diyarbakır, Turkey.
authors.forename: Mahşuk
authors.initials: M
authors.lastname: Taylan
authors.affiliation: Chest Department, Malatya İnönü University Medicine Faculty, Malatya, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Yalçınsoy
authors.affiliation: Chest Department, Private Acibadem Hospital, İstanbul, Turkey.
authors.forename: Haluk C
authors.initials: HC
authors.lastname: Çalışır
authors.affiliation: Chest Department, Private Emsay Hospital, İstanbul, Turkey.
authors.forename: Ali Metin
authors.initials: AM
authors.lastname: Görgüner
authors.affiliation: Chest Department, Süreyyapaşa Chest Disease and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey.
authors.forename: Dilek
authors.initials: D
authors.lastname: Ernam
mesh_terms: D000759:Adjuvants, Anesthesia / Q000494:pharmacology; D000368:Aged; D019162:Anesthetics, Combined / Q000494:pharmacology; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D016292:Procedural Sedation / Q000009:adverse effects* / Q000639:trends; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D061705:Image-Guided Biopsy / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008482:Mediastinum / Q000473:pathology; D008874:Midazolam / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D015742:Propofol / Q000008:administration & dosage / Q000494:pharmacology*; D012189:Retrospective Studies
chemical_list: D000759:Adjuvants, Anesthesia; D019162:Anesthetics, Combined; D006993:Hypnotics and Sedatives; D008874:Midazolam; D015742:Propofol
keywords: EBUS-TBNA; midazolam; propofol; sedation