Lyndsay L Madden1, John Ward2, Anne Ward3, VyVy N Young4, Libby J Smith4, David G Lott5, Paul C Bryson6, Matthew S Clary7, Phillip A Weissbrod8, Jonathan M Bock9, Joel H Blumin9, Clark A Rosen4. 1. Department of Otolaryngology, Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A. 2. Department of Cardiology, University of Pittsburgh Medical Center-Mercy Division, Pittsburgh, Pennsylvania, U.S.A. 3. Department of Anesthesiology, University of Pittsburgh Medical Center. 4. Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A. 5. Department of Otolaryngology, Mayo Clinic, Scottsdale, Arizona, U.S.A. 6. Department of Otolaryngology, Cleveland Clinic, Cleveland, Ohio, U.S.A. 7. Department of Otolaryngology, University of Colorado, Denver, Colorado, U.S.A. 8. Department of Otolaryngology, University of California-San Diego, San Diego, California, U.S.A. 9. Department of Otolaryngology, Medical College of Wisconsin, Milwaukee, Wisconsin, U.S.A.
Abstract
OBJECTIVES: Currently, there are no cardiovascular (CV) preprocedure screening parameters for patients undergoing in-office laryngeal procedures (IOLP). Studies have shown significant changes in CV measures for IOLP. The aim was to develop and evaluate a pre-IOLP CV screening protocol. METHODS: Review of IOLP literature and consultation with an anesthesiologist and cardiologist led to the development of CV parameters and questions related to four metabolic equivalents (METS) of work as a patient-screening tool before IOLP. A separate cohort was screened with only a modified CV protocol. All patients were screened for heart rate (HR) and blood pressure (BP) elevation prior to the procedure. Need for further CV evaluation was characterized as systolic blood pressure BP >160, diastolic BP >100, and/or HR >110 beats/minute. Patients whose BP/HR exceeded these values were referred to their primary care physician (PCP) before re-screening. If parameters were exceeded again at the second screen, then the procedure was done under monitored anesthesia care. RESULTS: The first study phase included 56 patients. The fail rate was 40% largely related to four METS of work. The second study phase included 440 patients. The screen fail rate was 15 patients of 572 (2.6%). Of these, 12 patients of 132 (9.1%) failed the initial screen and were sent to their PCP for further evaluation, and five of 440 (1.4%) patients failed on the day of the procedure. Overall, five of 440 (1.5%) patients would qualify to have their site of service changed for their laryngology procedure from an unmonitored to a monitored setting due to the prescreening criteria. CONCLUSION: Few patients needed further workup based upon the in-office CV parameters set in this study. Patients with CV risk factors were identified by the screening protocol. Having established hemodynamic parameters in place may improve the safety of IOLP with a very low physician burden. LEVEL OF EVIDENCE: 2b Laryngoscope, 127:1845-1849, 2017.
OBJECTIVES: Currently, there are no cardiovascular (CV) preprocedure screening parameters for patients undergoing in-office laryngeal procedures (IOLP). Studies have shown significant changes in CV measures for IOLP. The aim was to develop and evaluate a pre-IOLP CV screening protocol. METHODS: Review of IOLP literature and consultation with an anesthesiologist and cardiologist led to the development of CV parameters and questions related to four metabolic equivalents (METS) of work as a patient-screening tool before IOLP. A separate cohort was screened with only a modified CV protocol. All patients were screened for heart rate (HR) and blood pressure (BP) elevation prior to the procedure. Need for further CV evaluation was characterized as systolic blood pressure BP >160, diastolic BP >100, and/or HR >110 beats/minute. Patients whose BP/HR exceeded these values were referred to their primary care physician (PCP) before re-screening. If parameters were exceeded again at the second screen, then the procedure was done under monitored anesthesia care. RESULTS: The first study phase included 56 patients. The fail rate was 40% largely related to four METS of work. The second study phase included 440 patients. The screen fail rate was 15 patients of 572 (2.6%). Of these, 12 patients of 132 (9.1%) failed the initial screen and were sent to their PCP for further evaluation, and five of 440 (1.4%) patients failed on the day of the procedure. Overall, five of 440 (1.5%) patients would qualify to have their site of service changed for their laryngology procedure from an unmonitored to a monitored setting due to the prescreening criteria. CONCLUSION: Few patients needed further workup based upon the in-office CV parameters set in this study. Patients with CV risk factors were identified by the screening protocol. Having established hemodynamic parameters in place may improve the safety of IOLP with a very low physician burden. LEVEL OF EVIDENCE: 2b Laryngoscope, 127:1845-1849, 2017.
Authors: Brian O Hernandez; Moeko Nagatsuka; Stephen Carter Wright; Amanda J Marcellino; Benjamin D Lovin; Francis O Walker; Lyndsay L Madden Journal: J Voice Date: 2021-02-01 Impact factor: 2.300