Non-intubated general anesthesia based on Bi-spectral index monitoring: Case reports of 2 patients undergoing endo-bronchial ultrasound guided trans-bronchial needle aspiration

RATIONALE: Endo-bronchial ultrasound guided trans-bronchial needle aspiration (EBUS-TBNA) has been widely accepted as a safe and efficient technique for diagnosing patients with mediastinal/hilar lymphadenopathy and suspected cases of lung cancer. An effective anesthetic technique should provide comfort and quick recovery of patients while allowing the clinicians to obtain adequate tissue sample. Therefore we combined mask ventilation support (SIMV), BIS monitoring, and short-acting medication to achieve the effect mentioned above. PATIENT CONCERNS: In this report, both patients had lung mass accompanied by cough that lasted for >2 weeks, and were admitted to hospital for further diagnosis and treatment to clarify the nature of the mass. To make a definite diagnosis, EBUS-TBNA examination was performed under general anesthesia. Both patients had no salient past history. DIAGNOSIS: Case 1 was diagnosed as tumor or pneumonia based on the right lung shadow. Case 2 was diagnosed with squamous cell carcinoma of the right lung with right hilar lymph node metastasis. The diagnostic results of both patients were based on pathological examination of tissues obtained by EBUS-TBNA, of which case 1 required further confirmation by lung biopsy. INTERVENTION: Both the patients received antibiotic treatment before EBUS-TBNA. We used the mask ventilation supported by SIMV mode without using muscle relaxant, thus providing a guarantee for rapid and high-quality recovery of patients. OUTCOMES: During EBUS-TBNA, the vital signs of the 2 patients were stable. Both patients recovered within 5 minutes after we stopped pumping general anesthetics. None of the patient complained of any discomfort and felt comfortable. No complications occurred during and 3 months after EBUS-TBNA examination. LESSONS: The obtained results showed that this anesthesia scheme can provide appropriate depth of anesthesia for patients undergoing EBUS-TBNA examination, while ensuring rapid and high-quality recovery of patients.