Remifentanil Target-controlled Infusion Versus Standard of Care for Conscious Sedation During Ultrasound-guided Transbronchial Needle Aspiration and Biopsy: A Randomized, Prospective, Control Study.

IF 3.3 Q2 RESPIRATORY SYSTEM Journal of Bronchology & Interventional Pulmonology Pub Date : 2024-09-12 eCollection Date: 2024-10-01 DOI:10.1097/LBR.0000000000000989
Simone Scarlata, Valentina Scaduto, Lucio Paglione, Giuseppe Pascarella, Alessandro Strumia, Federica Bruno, Raffaele Antonelli Incalzi, Massimiliano Carassiti, Felice Eugenio Agrò, Fabio Costa
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Abstract

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure that has become an important tool in the diagnosis and staging of mediastinal lymph node lesions in lung cancer. Adequate sedation is an important part of the procedure as it provides patient comfort and potentially increases diagnostic yield. The sedation modality varies among centers and includes moderate sedation/conscious sedation, deep sedation, and general anesthesia. The object of this study will be the evaluation of patient's comfort and level of satisfaction with the involved health care providers (bronchoscopist and anesthesiologist) of remifentanil administration in target-controlled infusion (TCI) for conscious sedation in patients undergoing EBUS‑TBNA, with a prospective randomized study design versus the of standard sedation protocol with midazolam and/or fentanest and/or propofol.

Methods: This study was carried out at the "Campus Biomedico di Roma" University Hospital between September 2021 and November 2021, with a total number of 30 patients enrolled who met the eligibility criteria, randomly divided into 2 groups: group 1 "REMIFENTANIL TCI" (experimental group) where the patients performed the EBUS-TBNA procedure under conscious sedation with infusion of remifentanil TCI with a target between 3 ng/mL and 6 ng/mL and group 2 "STANDARD" (control group) with patients undergoing conscious sedation with the association of midazolam and/or fentanest and/or propofol in refracted boluses based on clinical needs. Complications, safety, and level of satisfaction of the operator, the anesthesiologist, and the patient were evaluated.

Results: The results show that sedation with remifentanil in TCI can improve the comfort level of patients, reducing the risks associated with the procedure (lower frequency of oversedations and hypotension), allowing for greater intraprocedural safety. Furthermore, the level of satisfaction of the anesthesiologist and that of the operator appears to be significantly higher in the Remifentanil group.

Conclusion: The execution of a mild to moderate sedation with Remifentanil in TCI in patients undergoing EBUS is safe, tolerated, and allows to obtain greater intraprocedural comfort. Further studies and larger and more representative samples are obviously needed to confirm and strengthen the validity of a remifentanil TCI-based sedation in endoscopic diagnostics.

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雷米芬太尼目标控制输注与超声引导下经支气管针抽吸和活检过程中意识镇静的标准护理:一项随机、前瞻性对照研究。
背景:支气管内超声引导下经支气管针吸术(EBUS-TBNA)是一种微创手术,已成为肺癌纵隔淋巴结病变诊断和分期的重要工具。充分的镇静是手术的重要组成部分,因为它能让患者感到舒适,并有可能提高诊断率。各中心的镇静方式各不相同,包括中度镇静/意识镇静、深度镇静和全身麻醉。本研究的目的是通过前瞻性随机研究设计,对接受EBUS-TBNA检查的患者使用瑞芬太尼靶控输注(TCI)进行意识镇静与使用咪达唑仑和/或芬太尼和/或丙泊酚的标准镇静方案进行对比,评估患者的舒适度以及对相关医护人员(支气管镜医师和麻醉医师)的满意度:本研究于 2021 年 9 月至 2021 年 11 月期间在 "Campus Biomedico di Roma "大学医院进行,共招募了 30 名符合资格标准的患者,随机分为两组:第一组为 "REMIFENTANIL TCI"(实验组),患者在有意识镇静的情况下进行 EBUS-TBNA 手术,输注瑞芬太尼 TCI,目标值介于 3 ng/mL 和 6 ng/mL 之间;第二组为 "STANDARD"(对照组),患者在有意识镇静的情况下,根据临床需要联合使用咪达唑仑和/或芬太尼和/或异丙酚。对并发症、安全性以及操作者、麻醉师和患者的满意度进行了评估:结果表明,在 TCI 中使用瑞芬太尼镇静可提高患者的舒适度,降低手术相关风险(降低过度镇静和低血压的频率),提高手术安全性。此外,瑞芬太尼组的麻醉师和操作者的满意度似乎明显更高:结论:在TCI中使用瑞芬太尼对接受EBUS检查的患者进行轻度至中度镇静是安全、可耐受的,并能获得更高的术中舒适度。显然,还需要更多的研究和更大规模、更具代表性的样本来证实和加强瑞芬太尼TCI镇静在内窥镜诊断中的有效性。
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CiteScore
4.40
自引率
6.10%
发文量
121
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