Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an increasingly used mediastinal sampling technique. Many centres use conscious sedation in an ambulatory setting to optimise the flow of patients, save costs and shorten recovery time. The only EBUS-TBNA patient satisfaction study published so far used deep conscious sedation with propofol. To our knowledge, ours is the largest prospective study evaluating the experience of patients undergoing EBUS-TBNA using light conscious sedation without propofol. Objectives: To evaluate the patient tolerability of EBUS-TBNA under mild conscious sedation. Methods: Eighty-two consecutive patients between January 2011 and November 2011 requiring EBUS-TBNA under light conscious sedation for either mediastinal staging of lung cancer or the diagnosis of suspected mediastinal disease due to malignancy or granulomatous disease were invited to complete a questionnaire after the intervention. The collection of data included the diagnostic yield, the number and size of nodes sampled and the dose of sedative medication administered. Results: The average dose of sedative agents administered was 59.4 μg fentanyl and 3.2 mg midazolam. The sensitivity of EBUS-TBNA for the cancer staging, cancer diagnosis and granulomatous disease cohorts was 90.0, 94.1 and 87.5%, respectively. The most commonly reported symptom was a cough in 65 (93%) patients. Of these patients, 46 (71%) described the severity as being mild. All but 9 patients (61/70 or 87%) stated that they would definitely or probably undergo a repeat EBUS-TBNA. Conclusions: This single-centre UK study confirms that EBUS-TBNA under light conscious sedation is a well-tolerated procedure maintaining the expected diagnostic performance, with patients reporting a high degree of satisfaction with both the test and the information received beforehand.

1.
The diagnosis and treatment of lung cancer. NICE clinical guideline. http://publications.nice.org.uk/lung-cancer-cg121 (accessed 11 June 2012).
2.
Gompelmann D, Herth FJ: Role of endobronchial and endoscopic ultrasound in pulmonary medicine. Respiration 2014;87:3-8.
3.
Pillai A, Medford AR: Greater physician involvement improves coding outcomes in endobronchial ultrasound-guided transbronchial needle aspiration procedures. Respiration 2013;85:417-421.
4.
Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP: Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982;5:649-655.
5.
Medford AR, Bennett JA, Free CM, Agrawal S: Mediastinal staging procedures in lung cancer: EBUS, TBNA and mediastinoscopy. Curr Opin Pulm Med 2009;15:334-342.
6.
Lilenbaum RC: Treatment of patients with advanced lung cancer and poor performance status. Clin Lung Cancer 2004;S71- S74.
7.
Medford AR, Agrawal S, Free CM, Bennett JA: A prospective study of conventional transbronchial needle aspiration: performance and cost utility. Respiration 2010;79:482-489.
8.
Medford AR: Convex probe endobronchial ultrasound: pitfalls, training and service issues. Br J Hosp Med 2011;6:312-317
9.
Lechtzin N, Rubin HR, White P, Jenckes M, Diette G: Patient satisfaction with bronchoscopy. Am J Resp Crit Care Med 2002;166:1326-1331.
10.
Sun BC, Adams J, Orav EJ, Rucker DW, Brennan TA, Burstin HR: Determinants of patient satisfaction and willingness to return with emergency care. Ann Emerg Med 2000;35:426-434.
11.
Steinfort DP, Irving LB: Patient satisfaction during endobronchial ultrasound-guided transbronchial needle aspiration performed under conscious sedation. Respir Care 2010;55:702-706.
12.
American Society of Anesthesiologists: Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002;96:1004-1017.
13.
Medford AR, Agrawal S, Free CM, Bennett JA: A performance and theoretical cost analysis of endobronchial ultrasound-guided transbronchial needle aspiration in a UK tertiary respiratory centre. QJM 2009;102:859-864.
14.
Oki M, Saka H, Kitagawa C, Kogure Y, Murata N, Adachi T, Ando M: Rapid on-site cytologic evaluation during endobronchial ultrasound-guided transbronchial needle aspiration for diagnosing lung cancer: a randomized study. Respiration 2013;85:486-492.
15.
Low A, Medford AR: Endobronchial ultrasound-guided transbronchial needle aspiration. Rev Recent Clin Trials 2013;8:61-71.
16.
Carrasquilo O, Orav EJ, Brennan TA, Burstin HR: Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med 1999;14:82-87.
17.
Medford AR: Learning curve for endobronchial ultrasound-guided transbronchial needle aspiration. Chest 2012;141:1643-1644.
18.
Konge L, Annema J, Clementsen P, Minddal V, Vilmann P, Ringsted C: Using virtual-reality simulation to assess performance in endobronchial ultrasound. Respiration 2013;86:59-65.
19.
Stather DR, Maceachern P, Rimmer K, Hergott CA, Tremblay A: Validation of an endobronchial ultrasound simulator: differentiating operator skill level. Respiration 2011;81:325-332.
20.
Maguire GP, Rubinfeld AR, Trembath PW, Pain MC: Patients prefer sedation for fibreoptic bronchoscopy. Respirology 1998;3:81-85.
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