A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures

Lyndsay L. Madden, John Ward, Anne Ward, Vy Vy N. Young, Libby J. Smith, David G Lott, Paul C. Bryson, Matthew S. Clary, Phillip A. Weissbrod, Jonathan M. Bock, Joel H. Blumin, Clark A. Rosen

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1845-1849
Number of pages5
JournalLaryngoscope
Volume127
Issue number8
DOIs
StatePublished - Aug 1 2017

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Otolaryngology
Blood Pressure
Metabolic Equivalent
Heart Rate
Primary Care Physicians
Laryngoscopes
Referral and Consultation
Anesthesia
Hemodynamics
Physicians

Keywords

  • Endoscopy
  • hypertension
  • laryngoscopy
  • larynx
  • office-based surgery
  • tachycardia
  • vocal fold

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Madden, L. L., Ward, J., Ward, A., Young, V. V. N., Smith, L. J., Lott, D. G., ... Rosen, C. A. (2017). A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. Laryngoscope, 127(8), 1845-1849. https://doi.org/10.1002/lary.26481

A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. / Madden, Lyndsay L.; Ward, John; Ward, Anne; Young, Vy Vy N.; Smith, Libby J.; Lott, David G; Bryson, Paul C.; Clary, Matthew S.; Weissbrod, Phillip A.; Bock, Jonathan M.; Blumin, Joel H.; Rosen, Clark A.

In: Laryngoscope, Vol. 127, No. 8, 01.08.2017, p. 1845-1849.

Research output: Contribution to journalArticle

Madden, LL, Ward, J, Ward, A, Young, VVN, Smith, LJ, Lott, DG, Bryson, PC, Clary, MS, Weissbrod, PA, Bock, JM, Blumin, JH & Rosen, CA 2017, 'A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures', Laryngoscope, vol. 127, no. 8, pp. 1845-1849. https://doi.org/10.1002/lary.26481
Madden, Lyndsay L. ; Ward, John ; Ward, Anne ; Young, Vy Vy N. ; Smith, Libby J. ; Lott, David G ; Bryson, Paul C. ; Clary, Matthew S. ; Weissbrod, Phillip A. ; Bock, Jonathan M. ; Blumin, Joel H. ; Rosen, Clark A. / A cardiovascular prescreening protocol for unmonitored in-office laryngology procedures. In: Laryngoscope. 2017 ; Vol. 127, No. 8. pp. 1845-1849.
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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.",
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