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Timing of hemodynamic changes during transnasal endoscopic surgery
Molly Naunheim1, Katherine C Yung1, Mark Courey1
1Department of Otolaryngology-Head and Neck Surgery, Division of Laryngology, University of California-San Francisco Medical Center, San Francisco, California, U.S.A.
The Laryngoscope
|November 5, 2015
Summary
Transnasal flexible endoscopic procedures cause significant heart rate and blood pressure increases. Anesthetic application and scope positioning are key moments for vital sign changes, especially in asthma patients.
Area of Science:
- Otolaryngology
- Cardiovascular Physiology
Background:
- Transnasal flexible endoscopic (TNFE) procedures are less invasive than general anesthesia laryngoscopy.
- However, TNFE is associated with significant increases in heart rate and blood pressure.
Purpose of the Study:
- Identify the most hemodynamically stimulating phase of TNFE procedures.
- Inform targeted pharmacotherapy to maintain hemodynamic stability during TNFE.
Main Methods:
- Retrospective chart review of adult patients undergoing TNFE.
- Analysis of vital signs recorded at 5-minute intervals.
- Statistical analysis using Wilcoxon signed rank and rank sum tests.
Main Results:
- Significant increases observed in heart rate (13 bpm), systolic BP (27 mmHg), and diastolic BP (26.5 mmHg).
- Greatest heart rate and saturation changes occurred during nasal/laryngeal anesthetic application and scope positioning.
- Asthma and coronary artery disease correlated with greater heart rate changes.
Conclusions:
- TNFE procedures induce significant vital sign fluctuations.
- Heart rate and saturation changes peak during preparation; blood pressure elevates during laryngeal intervention.
- Asthma patients exhibit more pronounced changes, suggesting a need for controlled environments.
