Remifentanil Target-Controlled Infusion for Conscious Sedation in Endobronchial Ultrasound-Guided Transbronchial Needle
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RESEARCH LETTER
Remifentanil Target‑Controlled Infusion for Conscious Sedation in Endobronchial Ultrasound‑Guided Transbronchial Needle Aspiration (EBUS‑TBNA): A Case Series Simone Scarlata1 · Fabio Costa2 · Giuseppe Pascarella2 · Alessandro Strumia2 · Raffaele Antonelli Incalzi1 · Felice E. Agrò2
© Springer Nature Switzerland AG 2020
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become a standard procedure in the diagnosis and staging of lung cancer [1]. Sedation method is one of the crucial steps in EBUS-TBNA procedures. A successful sedation provides a comfortable environment for the patient, while enabling the bronchoscopist to obtain adequate tissue. The choice of sedation should be made according to several factors. Deep sedation may be preferred in cases that require additional procedures, such as endobronchial stent, besides EBUS/TBNA, or in centres where trainees are still acquiring skills for such a procedure [2]. Moreover, deep sedation might be suitable foro EBUS/ TBNA procedures where comprehensive staging or small pulmonary node sampling is carried out, particularly by novice bronchoscopists [3]. However, for uncomplicated cases with experienced performers, either deep sedation or moderate or conscious sedation have similar outcomes [4]. Due to the potential to maintain adequate patient comfort without significantly affecting ventilation and hemodynamic status, as well as providing adequate swallowing and decreasing cough reflexes [5], conscious sedation has been proposed as a valid alternative to deep sedation. Conscious sedation is defined as “a druginduced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions * Simone Scarlata [email protected] 1
Geriatrics, Unit of Respiratory Pathophysiology, Campus Bio Medico University and Teaching Hospital, Via Alvaro del Portillo 200, 00128 Rome, Italy
Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Campus Bio Medico University and Teaching Hospital, Via Álvaro del Portillo 200, 00128 Rome, Italy
2
are required to maintain cardiovascular function or a patent airway, and spontaneous ventilation is adequate” [6]. The procedure, however, could be made more tolerable. The most most common drugs used to achieve conscious sedation are propofol or the administration of a combination of benzodiazepines and opiates [5, 7, 8]. These, however, may easily cause loss of airway, carrying the risk of hypoxia and inhalation, or relevant hypotension with serious consequences, which may occur both intraoperatively and during the recovery period [9]. These risks may be even higher in patients with a lung disease-related respiratory impairment, obesity, or heart disease. The ideal sedative should be easy to use, with rapid onset, short duration of action, and rapid recovery. Remifentanil is an interesting short-acting opioid to use in this area, because of its sedative, analgesic,
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