Introduction Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an increasingly used mediastinal sampling technique recommended by NICE¹ for staging and diagnosis of non-small cell lung cancer. It is also used to diagnose unexplained accessible mediastinal adenopathy and lesions. Many EBUS-TBNA centres use conscious sedation in an ambulatory setting to optimise patient flow, save costs and shorten recovery time. The size of the EBUS-TBN. A scope with an external diameter of just below 7mm requires it to be inserted orally, which has been associated with lower patient satisfaction at bronchoscopy in the past.² There is only one published EBUS-TBN. A patient satisfaction study which used deep conscious sedation with propofol and was not a UK study.³ This study was carried out to investigate the experience of patients undergoing EBUS-TBNA using mild conscious sedation without propofol in a UK setting.

Methods 45 consecutive patients requiring EBUS-TBNA for investigation of unexplained mediastinal adenopathy were invited to complete a questionnaire post procedure. EBUS-TBNA was performed under light conscious sedation as previously described.4 The average dose of intravenous sedatives was also recorded.

Results The average age of the 38/45 (84%) patients who completed the questionnaire was 59.0 years and 24/33 (72%) patients were male. Five patients had previously undergone fibreoptic bronchoscopy. The most common reason for referral was for diagnosis of suspected malignancy (30/45, 67%).

All patients felt that they had been provided with adequate written and verbal information, been given adequate opportunity to ask questions and had all potential risks explained to them prior to the test.

The average dose of sedative agents administered was 59.4 mcg fentanyl and 3.2 mg midazolam. The most commonly reported symptom was cough in 35 (92%) patients. Of these patients, 27 (78%) described the severity as being mild. All but 3 patients (35/38, 92%) stated that they would definitely or probably undergo a repeat EBUS-TBNA. No complications were reported.

Conclusions This UK single centre study demonstrates that EBUS-TBNA under mild conscious sedation (without propofol) is a well tolerated procedure with patients reporting a high degree of satisfaction with both the test and the information received prior to having the test.

References

1. The diagnosis and Treatment of Lung Cancer. NICE clinical guideline. http://publications.nice.org.uk/lung-cancer-cg121. Accessed 11th June 2012.

2. Lechtzin N, Rubin HR, White P et al. Patient satisfaction with bronchoscopy. Am J Resp Crit Care Med 2002; 166(10): 1326–31.

3. Steinfort DP, Irving LB. Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation. Respiratory Care 2010; 55(6): 702–6.

4. Medford AR, Agrawal S, Free CM et al. A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM 2009; 102(12): 859–64.