EBUS TBNA with rigid bronchoscopy, jet ventilation and general anesthesia – A review of procedural, anesthesia & post recovery times

Introduction: Flexible bronchoscopy (FB) with moderate sedation (MS) is the optimal technique for airway evaluation. Convex probe endobronchial ultrasound transbronchial needle aspiration (CP-EBUS TBNA) with above is preferred in most of the centers. It is argued, EBUS with FB and MS provide adequate biopsy, lower costs and quick recovery times. Aims & Objectives: We report our experience of rigid bronchoscopy (RB) with jet ventilation (JV) and IV general anesthesia (GA) as an alternative to FB and MS. Methods & Material: A retrospective review of prospectively collected data of 105 cases of CP-EBUS TBNA with RB and GA performed in the interventional pulmonology suite of our institution. Post recovery times were calculated in holding area. Rigid intubation with JV and IV sedation (propofol, mivacurium/cisatracurium and remifentanyl) was used.All data was collected by anesthesia staff. Results: Of the total 105 cases, 71 men and 34 women had an average age of 68.2 years. The average total GA anesthesia time was 46 mts:52 secs, average total EBUS procedural time was 31 mts:17 secs. Average total no. of lymph node biopsied were 3.2. The average total recovery time was 90 mts. In addition we performed 50 forceps biopsies, 37 brush biopsies, 4 cryo biopsies and 22 catheter biopsies. No post-procedural complications were recorded. Conclusion: We conclude that EBUS TBNA can be performed efficiently and safely with RB, JV and IV GA. Advantage of performing additional therapeutic and diagnostic procedures with a secured airway during bronchoscopy is given.