Impact of different sedation modalities on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important tool in diagnosis and staging of lung and mediastinal disease. However, opinions regarding patient sedation are controversial. Moderate sedation, deep sedation and general anesthesia are widely used with different criteria by many centers. The choice of sedation varies also depending on the type of operator performing the EBUS-TBNA and the location. The operator can be either a thoracic surgeon or a pulmonologist. The thoracic surgeon can have both the endoscopy unit and the operative room available and consequently can perform a triage of patients to be distributed in the two locations. The presence or absence of the anesthesiologist is another variable of the different sedation protocols. In many countries, including Italy, the use of some drugs is restricted to anesthesiologist; therefore, a whole series of sedation protocols performed by bronchoscopists alone would not be reproducible. What emerged from the data analysis is that both mild sedation and deep sedation can be acceptable approaches for EBUS-TBNA. General anesthesia, despite allowing operator’s comfort, might be excessive for a maneuver such as EBUS-TBNA and can be proposed in selected cases. The choice about sedation should be modulated on the specific patient’s need respecting the operator’s best practice.