Dexmedetomidine Moderate Sedation Versus General Anesthesia on the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Randomized Controlled Study

Abstract

Background: One of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the level of sedation. Objectives: Therefore, we aimed to compare dexmedetomidine (DEX) as moderate sedation (MS) versus general anesthesia (GA) on the diagnostic yield of EBUS-TBNA. Methods: This randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as American Society of Anesthesiologists (ASA) II or III, and scheduled for EBUS-TBNA. Patients were randomly allocated into two equal groups. Group D received 1 μg/kg fentanyl 2 minutes before induction with a 1 μg/kg infusion of DEX for 10 minutes, then maintenance with 0.5 - 1 μg/kg/h aiming for a Ramsey Sedation Scale of 4 - 5 while preserving hemodynamics. Group GA received 1 μg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes). Results: Group D had a significantly higher rate of recalling the procedure (P = 0.005) and a lower rate of shortness of breath compared to group GA (P = 0.038). Intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group D compared to group GA (P < 0.05). Intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. Recovery time was significantly shorter in group D compared to group GA (P < 0.001). Conclusions: Compared to GA, MS with DEX showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in EBUS-TBNA.