dexmedetomidine moderate sedation versus general anesthesia on the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration: a randomized controlled study

Background: one of the factors that affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (ebus-tbna) is the level of sedation. objectives: therefore, we aimed to compare dexmedetomidine (dex) as moderate sedation (ms) versus general anesthesia (ga) on the diagnostic yield of ebus-tbna. methods: this randomized open-label controlled trial was carried out on 70 patients older than 18 years of age, classified as american society of anesthesiologists (asa) ii or iii, and scheduled for ebus-tbna. patients were randomly allocated into two equal groups. group d received 1 μg/kg fentanyl 2 minutes before induction with a 1 μg/kg infusion of dex for 10 minutes, then maintenance with 0.5 - 1 μg/kg/h aiming for a ramsey sedation scale of 4 - 5 while preserving hemodynamics. group ga received 1 μg/kg fentanyl, 2 mg/kg propofol, and 0.5 mg/kg atracurium (then 0.1 mg/kg every 20 minutes). results: group d had a significantly higher rate of recalling the procedure (p = 0.005) and a lower rate of shortness of breath compared to group ga (p = 0.038). intraoperative heart rate measurements at baseline were not significantly different between groups but were significantly lower at 5 min, 10 min, 15 min, 20 min, and at the end of surgery in group d compared to group ga (p < 0.05). intraoperative mean arterial blood pressure measurements at baseline, 5 min, 10 min, 15 min, 20 min, and at the end of surgery were not significantly different between groups. recovery time was significantly shorter in group d compared to group ga (p < 0.001). conclusions: compared to ga, ms with dex showed a comparable diagnostic yield with faster recovery time and better patient satisfaction, as evidenced by a willingness to repeat procedures when needed and less shortness of breath in ebus-tbna.