Satisfaction of patients and operators from sedation in EBUS-TBNA; the 'SEDATE' study

Introduction: There is no standardized practice for the use of sedation in EBUS-TBNA and hence there is a continuous debate about bronchoscopist -administered versus anaesthetist-administered sedation. Their impact in patient and operator satisfaction has not been thoroughly studied. Aim: To evaluate patients' and operators' satisfaction, complications and efficiency of EBUS-TBNA with propofol versus midazolam and fentanyl. Materials and methods: Adult patients, anaesthetists and bronchoscopists were offered a survey questionnaire after completion of each EBUS-TBNA. The questionnaire assessed demographics, type of sedation, complications, duration of procedure, operator's and patient's satisfaction. Results: During August 2013-January 2014, 133 patients (mean age 58.3 years) that underwent EBUS TBNA completed the questionnaire. Sixty patients received propofol+/- reminfentanyl (Group A) by an anaesthetist and 73/133 received midazolam and fentanyl (Group B) by the operator. The number of passes per lymph node and complications were not significantly associated with the type of sedation (p<0.05). Operators reported satisfaction in 80% (48/60) of Group A cases and 60% of Group B. Patients in group A reported less discomfort, less recall of procedure and less tendency to vomit than patients in group B and the majority(45/60)would be willing to return for the same procedure again. Conclusions: Propofol is an important drug for EBUS-TBNA sedation with immense benefits for both patients and operators. Its use should be encouraged in EBUS-TBNA and it should be offered by an anaesthetist or the operator provided that the latter has received appropriate training and the national guidelines permit this.