ABSTRACT
BACKGROUND: Different anesthetic protocols may influence endobronchial ultrasound-guided needle aspiration (EBUS-TBNA) outcomes, patient comfort, and even safety. In this study, two anesthesia techniques were assessed and compared for EBUS-TBNA. METHODS: A prospective, multicenter study was carried out. Patients were allocated to Group 1 (general anesthesia with neuromuscular blockade and controlled ventilation) and Group 2 (intravenous sedation). EBUS-TBNA accuracy was the primary outcome. Safety, patient comfort and satisfaction, and operators' difficulties were defined as secondary outcomes. RESULTS: Of the 115 patients enrolled (Group 1 = 59, Group 2 = 56), EBUS-TBNA was performed for hilar or mediastinal lesion diagnosis and lung cancer staging in, respectively, 77 (67%) and 38 (33%) patients. The numbers of lymph nodes stations (1.8 ± 1.0 vs. 1.7 ± 1.0, p = 0.472) and punctures per station (6.9 ± 3.1 vs. 6.0 ± 2.5, p = 0.084) were similar between groups. Adequate samples were obtained from 109 patients (97.3%) with similar diagnostic accuracy. Procedure duration was not significantly different (p = 0.348). Hemodynamic parameters and systolic and diastolic blood pressures were higher in Group 1 at the beginning and at the end of the procedure. Adverse events were equally distributed, and no significant differences were found regarding patient satisfaction and bronchoscopist/anesthesiologist difficulties. CONCLUSIONS: The type of anesthesia used did not influence EBUS-TBNA outcomes. EBUS-TBNA performed under sedation or general anesthesia did not affect the diagnostic yield, complication rate, and patients' comfort and satisfaction.
ABSTRACT
Density functional theory (DFT) calculations were performed on clusters [Os3(CO)10(α-diimine)], for α-diimine = 2,2'-bipyridine (BPY), N-isopropyl 2-iminomethylpyridine (IMP), and N, N'-diisopropyl-l,4-diaza-1,3-butadiene (DAB), together with their spectroscopic study. This important family of clusters is known to convert upon irradiation with visible light into short-lived biradicals and long-lived zwitterions from a σπ* (SBLCT) excited state that has not been described accurately thus far by quantum mechanical calculations. On the basis of the combined DFT, UV-vis absorption, and resonance Raman data, the lowest-lying visible absorption band is assigned to a σ(Os1-Os3)-to-π*(α-diimine) CT transition, for α-diimine = bpy and IMP, and to a strongly delocalized σ(Os1-Os3)π*-to-σ*(Os1-Os3)π* transition for conjugated nonaromatic α-diimine = DAB. The DFT calculations rationalize the experimentally determined characteristics of this electronic transition in the studied series: (i) The corresponding absorption band is the dominant feature in the visible spectral region. (ii) The CT character of the electronic excitation declines from α-diimine = bpy to IMP and vanishes for DAB. (iii) The excitation energies decrease in the order α-diimine = DAB > BPY > IMP. (iv) The oscillator strength shrinks in the order α-diimine = DAB > IMP > BPY. Reference photoreaction quantum yields measured accurately for the formation of a cluster zwitterion from [Os3(CO)10(IMP)] in strongly coordinating pyridine demonstrate that the optical population of the lowest-energy 1σπ* and relaxed 3σπ* excited states in the DFT model scheme is still capable of inducing the initial homolytic Os1-Os3 σ-bond splitting, although less efficiently than the optical excitation into neighbor higher-lying electronic transitions due to a higher potential barrier for the reaction from a dissociative (σσ*) state.
