title: Hemodynamic Parameters during Laryngoscopic Procedures in the Office and in the Operating Room.
abstract: Previous research has shown that office-based laryngoscopic procedures can induce hemodynamic changes, including tachycardia and severe hypertension, calling into question the safety of these procedures. However, comparison between office and operating room (OR) procedures has not been carried out. Therefore, we prospectively measured hemodynamic variables in both settings to compare hemodynamic changes between office and OR procedures.
  
  
  
  Prospective cohort study.
  
  
  
  Single academic center.
  
  
  
  Subjects undergoing office and OR laryngoscopic procedures were prospectively identified, and 92 OR and 70 office subjects were included. Heart rate and blood pressure were measured at established time points before, during, and after the procedures. Descriptive and comparative statistical analyses were conducted.
  
  
  
  Severe hemodynamic events, either tachycardia or severe hypertension (blood pressure >180 mm Hg systolic or >110 mm Hg diastolic), occurred significantly more frequently in OR than office procedures (41% vs 20%; P = .006). OR severe hemodynamic events occurred more commonly than previously reported rates in the office (41% vs 28%; P = .012). Regression analyses showed that the odds of having a severe hemodynamic event were 3.66 times higher in OR versus office procedures.
  
  
  
  Severe hemodynamic events are more likely to occur in the OR than in the office during laryngologic procedures. While larger studies will be required to establish rates of dangerous cardiovascular events in laryngoscopic procedures, hemodynamic parameters indicate that office-based procedures have a safety benefit for procedures that can be conducted in either setting.
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA tiernew@ccf.org.
authors.forename: William S
authors.initials: WS
authors.lastname: Tierney
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Chota
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Benninger
authors.affiliation: Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA Cleveland Clinic Quantitative Health Sciences, Cleveland, Ohio, USA.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Nowacki
authors.affiliation: Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA.
authors.forename: Paul C
authors.initials: PC
authors.lastname: Bryson
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007828:Laryngoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms; D061214:Patient Safety; D010824:Physicians' Offices; D011446:Prospective Studies
keywords: cardiovascular; hemodynamic; hypertension; laryngology; microlaryngoscopy; office based; safety; tachycardia; vital sign