The Effect of office-based flexible endoscopic surgery on hemodynamic stability

Because of technological advances in endoscopy equipment, office-based flexible endoscopic surgery (OBFES) is becoming more widespread and common in practice. In our experience, we have noticed that patients often have marked rises in heart rate (HR) and blood pressure (BP). However, to our knowledge, changes in hemodynamic stability during these procedures have never been studied. The primary aim of this study was to investigate changes in BP, HR, and oxygen (O(2)) saturation in patients undergoing unsedated laryngeal surgery.

Retrospective chart review.

Medical records for 31 consecutive subjects who underwent OBFES at the University of California, San Francisco Mt. Zion Endoscopy Suite from June 2008 to June 2009 were reviewed. Absolute values and changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), HR, and O(2) saturation from baseline were evaluated.

During the procedure, 9/31 patients had tachycardia (29%) and 7/31 had severe hypertension (23%). The mean change in HR was 14.6 beats/min (P < .0001), mean change in DBP was 18.5 mm of mercury (Hg) (P < .0001), mean change in SBP was 33.1 (P < .0001), and mean change in O(2) was 0.8 (P = .01). Older age groups had significantly higher baseline DBP (P = .02) and SBP (P = .0006), as well as procedural SBP (P = .0007). One procedure was terminated early secondary to unsafe rises in SBP and DBP. Change in DBP and SBP was not correlated with age.

Significant changes in hemodynamic status occur during OBFES. Clinicians should be aware of this and consider the risks these changes may pose to their patients. Monitoring during these procedures may be indicated.