Faculty Collaboration Database

A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. Laryngoscope 2017 Aug;127(8):1845-1849

Date

04/14/2017

Pubmed ID

28407258

DOI

10.1002/lary.26481

Scopus ID

2-s2.0-85017562812 (requires institutional sign-in at Scopus site)   8 Citations

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.

Author List

Madden LL, Ward J, Ward A, Young VN, Smith LJ, Lott DG, Bryson PC, Clary MS, Weissbrod PA, Bock JM, Blumin JH, Rosen CA

Authors

Joel H. Blumin MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
Jonathan Bock MD Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Blood Pressure
Cardiovascular Diseases
Clinical Protocols
Female
Heart Rate
Hemodynamics
Humans
Hypertension
Laryngoscopy
Male
Middle Aged
Office Visits
Patient Selection
Preoperative Care
Prospective Studies
Risk Assessment
Tachycardia
Young Adult