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Hemodynamic changes in patients undergoing office‐based sinus procedures under local anesthesia
Author(s) -
Chang Michael T.,
Jitaroon Kawinyarat,
Nguyen Teresa,
Yan Carol H.,
Overdevest Jonathan B.,
Nayak Jayakar V.,
Hwang Peter H.,
Patel Zara M.
Publication year - 2020
Publication title -
international forum of allergy and rhinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.503
H-Index - 46
eISSN - 2042-6984
pISSN - 2042-6976
DOI - 10.1002/alr.22460
Subject(s) - medicine , anesthesia , heart rate , mean arterial pressure , blood pressure , hemodynamics , lidocaine , prospective cohort study , anxiety , surgery , psychiatry
Background The objective of this study is to characterize changes in hemodynamics, pain, and anxiety during office‐based endoscopic sinus procedures performed under local anesthesia. Methods We conducted a prospective study of adults undergoing in‐office endoscopic sinus procedures under local anesthesia. Patients with American Society of Anesthesiologists (ASA) Physical Status Classification System class 1 or 2 were included. Anesthesia was administered by topical 4% lidocaine/oxymetazoline and submucosal injection of 1% lidocaine/1:200,000 epinephrine. Vital signs and pain were measured at baseline, postinjection, and 5‐minute intervals throughout the procedure. Anxiety levels were scored using the State‐Trait Anxiety Inventory (STAI). Univariate and multivariate regression analyses were performed to identify factors significantly associated with changes in each hemodynamic metric. Results Twenty‐five patients were studied. This cohort was 52% male, mean age of 57.8 ± 14.4 years, and Charlson Comorbidity Index (CCI) median of 2. Mean procedure duration was 25.0 ± 10.3 minutes. Mean maximal increase in systolic blood pressure (SBP) was 24.6 ± 17.8 mmHg from baseline. Mean maximal heart rate increase was 22.8 ± 10.8 beats per minute (bpm) from baseline. In multivariate regression analysis, when accounting for patient age, cardiac comorbidity, CCI, and ASA, older age was significantly associated with an increase of >20 mmHg in SBP ( p = 0.043). Mean pain score during procedures was 1.5 ± 1.3 with a mean maximum of 4.0 ± 2.6. STAI anxiety scores did not change significantly from preprocedure to postprocedure (32.8 ± 11.6 to 31.0 ± 12.6, p = 0.46). No medical complications occurred. Conclusion Although patients appear to tolerate office procedures well, providers should recognize the potential for significant fluctuations in blood pressure during the procedure, especially in older patients.