P183 Comparison of patient satisfaction between endobronchial ultrasound and flexible bronchoscopy performed under conscious sedation: a prospective study

Abstract

Background: Endobronchial ultrasound-guided transbronchial needleaspiration (EBUS-TBNA) is increasingly performed by respiratoryphysicians across the UK. Although patient satisfaction with flexiblebronchoscopy (FB) is high, there are no studies comparing patientsatisfaction with FB vs EBUS performed under conscious sedation. Methods: In this prospective study, patients completed a questionnaire2 h post-procedure when they were fully awake as determinedby the modified Aldrete score. The questionnaire consisted ofa 4-point Likert scale to record the degree of discomfort and a 5-point scale to record the overall satisfaction and willingness toreturn for the procedure. Both EBUS and FB were performed usingtopical lignocaine and intravenous midazolam. EBUS was performedby a consultant physician, whereas FB was performed by aconsultant physician or a specialty registrar. Results: 52 consecutive patients (mean age 65) undergoing EBUS and35 patients (mean age 66) undergoing FB completed the study.Although the mean dose of intravenous midazolam used in the EBUSgroup was higher (3.16 mg vs 2.52 mg; p<0.01), the level of sedation(determined by sedation score of 0-unresponsive to 6-agitated) prescopeinsertion was similar in both groups. The mean dose of topicallignocaine (excluding oropharyngeal lignocaine) was also similar inboth groups. The duration of procedure with EBUS was longercompared to FB (21.25 min vs 12.09 min; p<0.001). Despite this,there were no significant differences in the reported patient discomfortwith anaesthetic throat spray, transtracheal lignocaine injectionor scope insertion. Similarly, there were no significant differences inthe reported incidence of cough, dyspnoea, throat pain, chest pain,feeling of suffocation and overall tolerance of the procedure. Theoverall satisfaction for the procedure was 95% in the EBUS group and89% in the FB group, while 92% and 86% respectively were willing tohave the procedure again if needed. EBUS was diagnostic in 96%(mean lymph node size 1.6 cm) and there were no complications.Conclusion Patient satisfaction with EBUS-TBNA under conscioussedation is high. As EBUS services continue to expand, physicianscan perform this under conscious sedation with similar patientsatisfaction level as experienced with FB.