title: In-office vasovagal response after rhinologic manipulation.
abstract: BACKGROUND
  Advances in endoscopic sinus surgery have led to a greater number of in-office procedures away from the traditional operating room setting. Rhinologists acting independently of anesthesiologists must be prepared for potential complications, such as vasovagal response (VVR), that may arise during in-office rhinologic manipulations. In this study, we review our experience with this condition and discuss risk factors and a management algorithm for in-office VVR.
  
  
  METHODS
  A retrospective analysis at a large tertiary referral center was performed on all patients undergoing in-office endoscopic procedures with rhinologic manipulation between July 2008 and June 2012. A total of 4973 patients underwent in-office endoscopic procedures and 8 patients with VVR were identified. Demographic data, diagnosis, procedure performed, and outcomes were reviewed.
  
  
  RESULTS
  Eight patients out of 4973 (0.16%) experienced VVR during in-office endoscopic procedures. Seven (87.5%) of these 8 patients recovered from the VVR within 30 minutes and subsequently completed their scheduled procedure. One (12.5%) of the 8 patients did not fully recover after 30 minutes and was sent to the Emergency Department, where he was stabilized and subsequently discharged. The most common comorbidities in these 8 patients with VVR were hypercholesterolemia in 3 patients (37.5%), and hypertension and benign prostatic hyperplasia, each found in 2 patients (25.0%).
  
  
  CONCLUSIONS
  Although the incidence of VVR during rhinologic procedures is low, rhinologists should be familiar with this condition and be prepared for its management.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Radvansky
authors.forename: Qasim
authors.initials: Q
authors.lastname: Husain
authors.forename: Deepa V
authors.initials: DV
authors.lastname: Cherla
authors.forename: Osamah J
authors.initials: OJ
authors.lastname: Choudhry
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059747:Nasal Surgical Procedures / Q000009:adverse effects*; D019990:Perioperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome