RT Journal Article
SR Electronic
T1 Thoracoscopic lung biopsy under regional anesthesia for interstitial lung disease
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP 255
OP 259
DO 10.1136/rapm-2019-100686
VO 45
IS 4
A1 Chitaru Kurihara
A1 Brian Tolly
A1 Andre DeWolf
A1 Antoun Nader
A1 Samuel Kim
A1 David D Odell
A1 Angela C Argento
A1 G R Scott Budinger
A1 Ankit Bharat
YR 2020
UL http://rapm.bmj.com/content/45/4/255.abstract
AB Background Interstitial lung disease (ILD) management guidelines support lung biopsy-guided therapy. However, the high mortality associated with thoracoscopic lung biopsy using general anesthesia (GA) in patients with ILD has deterred physicians from offering this procedure and adopt a diagnostic approach based on high-resolution CT. Here we report that thoracoscopy under regional anesthesia could be a safer alternative for lung biopsy and effectively guide ILD treatment.Methods This was a single-center retrospective review of prospectively maintained database and consisted of patients who underwent thoracoscopic lung biopsy between March 2016 and March 2018. Patients were divided into two groups: (A) GA, and (B) regional anesthesia using monitored anesthesia care (MAC) and thoracic epidural anesthesia (TEA).Results During the study period, 44 patients underwent thoracoscopic lung biopsy. Of these, 15 underwent MAC/TEA. There were no significant differences between the two groups with regard to pulmonary function test and clinicodemographic profile. However, operative time and hospital stay were shorter in MAC/TEA group (32.5±18.5 min vs 50.8±18.4; p=0.004, 1.0±1.3 days vs 10.0±34.7 days; p<0.001, respectively). Eight patients in the GA group, but none in the MAC/TEA group, experienced worsening of ILD after lung biopsy (p=0.03). Additionally, one patient in the GA group died due to acute ILD worsening. No cases of MAC/TEA group had to be converted to GA. In all cases a pathological diagnosis could be made.Conclusions Thoracoscopy using regional anesthesia might be a safer alternative to lung biopsy in patients with ILD.