Anaesthetic management of endobronchial ultrasound guided trans bronchial needle aspiration: Our experience with laryngeal mask airway

Introduction: Endobronchial Ultrasound Guided Trans bronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic modality for evaluating intra thoracic lymph nodes, becoming one of the important tool in the armamentarium of pulmonologists. The size of the fiberscope and sharing of the airway with the bronchoscopist poses unique challenges to the anesthesiologist. In light of these developments it is important to develop an office based anesthesia technique for this relatively new procedure. Hence we did this descriptive cohort study. Aim: To describe the accuracy and anaesthetic management of EBUS-TBNA as a day care procedure, done with general anesthesia (GA). Materials and Methods: Data was collected from January 2017 to December 2017 at our institute from patients who underwent EBUS-TBNA under GA using second generation laryngeal mask airway (LMA). Specifically, hemodynamic status, Oxygen saturation, duration of the procedure, diagnostic yield and complications of the procedure were recorded. Results: 23 patients underwent EBUS-TBNA under GA. All patients were found to be hemodynamically stable with fluctuations in blood pressure and heart rate being less than 20% from the baseline with no episodes of desaturation .The average number of biopsies taken is 3.3, with average duration of the procedure being 67.0±17.6 (mean±SD) minutes. The incidence of post procedural complications like cough and sore throat were minimal. Successful diagnostic yield was found in all cases with no incidence of recall of the procedure. Conclusion: The performance of EBUS-TBNA under general anesthesia with LMA provides great hemodynamic stability and adequate ventilation in a shared airway. It demonstrates excellent diagnostic accuracy. It provides comfort to the patient and the good examination conditions to the bronchoscopist. Clinical Significance: Use of P-LMA solves the dilemma of managing ventilation during EBUS TBNA without affecting the diagnostic yield of the procedure.