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THE IMPORTANCE OF ANESTHESIA IN DIAGNOSTIC TESTS OF ENDOBRONCHIAL ULTRASOUND
JADRANKA KATANČIĆ
; Zagreb University Hospital Centre, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb, Croatia
MORENA MILIĆ
; Dubrava University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Dubrovnik University, Dubrovnik, Croatia
TATJANA GORANOVIĆ
; Sveti Duh University Hospital, Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb and Josip Juraj Strossmayer University of Osijek, School of Medicine, Osijek, Croatia
Abstract
A possible anesthetic procedure for diagnostic endobronchial ultrasound (EBUS) is presented. EBUS is a specifi c search for the diagnosis of newly emerged hilar and/or mediastinal lymphadenopathy and lung tumors. Anesthesia facilitates the performance of this diagnostic procedure for the patient and the physician. From previous studies, it is apparent that various anesthetic techniques are employed. The procedure can be performed in sedation with the application of local anesthetic and general anesthesia. When using local anesthetic sedation, the patient breathes spontaneously, general anesthesia maintains the respiratory tract with a laryngeal mask or an orotracheal tube. In the patient aged 57, body mass 94 kg, with regular pulmonary function according to ASA classifi cation, without known allergies, the EBUS diagnostic scan was indicated for increased lymph nodes in the mediastinum. Diagnostic EBUS is run on a remote site equipped with the Datex-Ohmeda S5 Aespire anesthetic device and the Philips IntelliVue MP60 monitor, and we adjusted the anesthetic process to the existing conditions. Heart rate, electrocardiogram, number of breaths, blood pressure, percentage of hemoglobin, oxygen saturation and pulse oximetry were monitored. Intravenous cannula was placed and infusion of 500 mL of 0.9% NaCl maintained. Following local anesthesia with 1-2 mL 1% lidocaine in the oropharyngeal area, the patient was sedated with midazolam (2.5 mg), n-fentanyl (5 mcg) and propofol (bolus 100 mg and continuous maintenance dose of 4 mg/min). After fl exible bronchoscopy through the nose for 5 min, the EBUS was continued through the mouth for 22 min. The diagnostic procedure took
a total of 27 min. During anesthesia, the patient was respiratory and hemodynamically stable. The patient breathed spontaneously with the addition of air/oxygen mixture 1:1, with a modality of 700 mL maximum volume and maximum frequency of 33/min. Such modifi cation achieved satisfactory ventilation and oxygen saturation at the periphery of 94±4%. Systemic blood pressure was 157±7 mm Hg and diastolic pressure 78±9 mm Hg. Heart rate was 88±8 min. After completing the diagnostic procedure, the patient woke up neatly. Anesthesia was without complications.
Keywords
endobronchial ultrasound (EBUS); anesthesia
Hrčak ID:
209078
URI
Publication date:
18.11.2018.
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