Effects of comorbidity and medication use on the haemodynamic status during office-based laryngeal procedures: a prospective cohort study

Abstract

Objective

Office-based laryngeal procedures are emerging as effective alternative modalities for vocal disorders. This study systematically investigates the haemodynamic status of patients, specifically focusing on the potential effects of underlying comorbidity and medication use.

Design

Prospective cohort study.

Setting

Tertiary referral center.

Participants

We prospectively recruited 214 consecutive patients who received office-based laryngeal procedures during January–December 2015. All procedures were performed under local anaesthesia without sedation, in an upright (sitting) position.

Main outcome measures

We measured heart rate, systolic and diastolic blood pressure, and oxygen saturations at baseline (before procedure), immediately after local anaesthesia to the pharynx and larynx, immediately after completing of procedure, and 20 min after the procedure.

Results

Systolic, diastolic blood pressures and heart rate all significantly increased after local anaesthesia, and gradually decreased after the procedure (p<0.01). Oxygen concentration remained unchanged. Patients with comorbidity and those receiving vasoactive medications showed significantly higher perioperative blood pressures than the other patients (p<0.05), but the trend remained similar. Prominent hypertension (systolic ≥160 mmHg or diastolic ≥ 100 mmHg) were noted in 17 patients, more commonly in patients with older age, higher baseline blood pressures, and receiving vasoactive medications. Only 2% of patients with normal baseline measurements developed prominent hypertension perioperatively. Tachycardia (heart rate ≥ 100 bpm) developed in 22 patients, more frequently in patients with higher baseline heart rates, and perceiving greater discomforts.

Conclusion

This study revealed that routine haemodynamic monitoring may not be necessary for all the office-based laryngeal procedures, but should be considered for older patients, those with higher baseline blood pressure or heart rate, sensitive patients who might be more susceptible to perioperative discomfort, and those receiving vasoactive medications.

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