title: Diagnostic Yield and Complications of EBUS-TBNA Performed Under Bronchoscopist-directed Conscious Sedation: Single Center Experience of 1004 Subjects.
abstract: BACKGROUND
  Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed under either conscious sedation or general anesthesia. Herein, we describe the diagnostic yield and complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation.
  
  
  METHODS
  This is a retrospective analysis of data collected in the bronchoscopy suite of this center on EBUS-TBNA or endoscopic ultrasound with a bronchoscope-guided fine needle aspiration (EUS-B-FNA) procedures performed between July 2011 and January 2016. All procedures were performed under bronchoscopist-directed conscious sedation with midazolam and pentazocine. The diagnostic yield, sample adequacy rate, complications, and doses of sedative agents are presented.
  
  
  RESULTS
  Of the total 1005 EBUS-TBNA/EUS-B-FNA procedures performed during the study period, 1004 were performed under conscious sedation in spontaneously breathing subjects [mean (SD) age, 45.9 (15.8) years; 378 (37.6%) women]. The mean (SD) doses of midazolam and pentazocine used were 2.53 (1.8) mg and 30.9 (6.9) mg, respectively. The diagnostic yield of the procedure (972 subjects) was 61.2%. Complications related to EBUS were observed in 60 (5.9%) subjects. Majority of them were minor and self-limiting; major complications occurred in 11 (1.1%) subjects and included respiratory failure requiring assisted ventilation (n=6), arrhythmia (n=3), and hypotension (n=2). Escalation of the level of care was needed in only 8 (0.8%) subjects.
  
  
  CONCLUSIONS
  EBUS-TBNA/EUS-B-FNA performed under bronchoscopist-guided conscious sedation was found to be safe and is associated with a reasonable diagnostic yield.
authors.affiliation: Departments of *Pulmonary Medicine †Cytology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
authors.forename: Sahajal
authors.initials: S
authors.lastname: Dhooria
authors.forename: Inderpaul S
authors.initials: IS
authors.lastname: Sehgal
authors.forename: Nalini
authors.initials: N
authors.lastname: Gupta
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Digambar
authors.initials: D
authors.lastname: Behera
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D001999:Bronchoscopy / Q000379:methods*; D016292:Procedural Sedation / Q000295:instrumentation*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008482:Mediastinum; D008874:Midazolam / Q000008:administration & dosage; D008875:Middle Aged; D010423:Pentazocine / Q000008:administration & dosage; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D008874:Midazolam; D010423:Pentazocine