Safety Evaluation of Dexmedetomidine Monitored Anesthesia Care for Endobronchial Ultrasound-guided Transbronchial Needle Aspiration
Lung cancer is the second most commonly diagnosed primary neoplasia in Canada accounting for
22 865 new cases in 2007. Recent randomized trials have shown a significantly better
diagnostic yield and fewer unnecessary thoracotomies with endobronchial ultrasound-guided
transbronchial needle aspiration (EBUS-TBNA) when compared to conventional TBNA for various
clinical conditions including peripheral pulmonary lesions and sarcoidosis. EBUS-TBNA are
now routinely performed in our institution for staging of pulmonary and mediastinal cancer.
EBUS-TBNA are performed under monitored anesthesia care (MAC) in the endoscopy suite at the
Centre de soins ambulatoires of the Hôpital Maisonneuve-Rosemont.
Remifentanil, used in combined regime or as single agent proved to be effective and safe for
MAC. Nonetheless, anesthesiologists are still confronted to the respiratory depression
profile of remifentanil and other commonly used agents. An analysis of the ASA Closed Claims
demonstrated that respiratory depression remains a significant drawback during MAC in remote
locations. Furthermore, patients with coexisting pulmonary diseases scheduled for EBUS-TBNA
are at increased risk of such complications.
The investigators hypothesize that compared to the use of remifentanil-based MAC protocol,
the use of dexmedetomidine-based MAC protocol for EBUS-TBNA will result in a lower incidence
of major respiratory and hemodynamic adverse events (bradypnea, apnea, oxygen desaturation,
hypotension, hypertension, bradycardia and tachycardia) with equivalent overall procedure
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