Best Evidence Topic: Does the Depth of Sedation Affect Diagnostic Yield of Endobronchial Ultrasound–guided Transbronchial Needle Aspiration?

Abstract

The ideal type of sedation during endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is still a matter of debate. We evaluated whether depth of sedation could affect the EBUS-TBNA results. We reviewed the literature until February 2020, and 11 studies (7 retrospective; 2 prospective observational; and 2 randomized controlled) provided the most applicable evidence to answer the question. All studies but one found that the depth of sedation did not affect diagnostic yield. Eight papers counted the number of lesions sampled per patient, and all studies but 1 found higher number of lesions biopsied with deep sedation. Seven papers counted the number of needle passes per lesion; 4 studies found higher number of passes with deep sedation; 1 study with conscious sedation; and 2 studies found no difference. Four studies evaluated lesion size, and 2 studies found smaller lesion biopsied with deep sedation. Ten papers evaluated complication rates, and 6 of these also analyzed escalation in level of care. All studies but one found that the depth of sedation was not significantly correlated with complication rates. Three studies evaluated patient satisfaction, showing no difference in relation to the depth of sedation. Only one study evaluated the cost of the procedure and found that deep sedation was associated with higher cost compared with conscious sedation. The depth of sedation did not affect EBUS-TBNA outcomes. Thus, conscious sedation and deep sedation remain 2 available strategies for EBUS-TBNA. The choice of one rather than the other strategy should be made considering several factors including physician’s experience, patient’s clinical history (ie, anxiety levels, psychotropic drug use, education level), the aim of EBUS-TBNA (ie, staging, diagnosis), and hospital local policy (availability of operating room and anesthesiologist).