In-office laryngeal procedures (IOLP) in Canada: current safety practices and procedural care

Abstract

BackgroundThe advent of chip tip technology combined with advanced endoscopy has revolutionized the field of laryngology in the past decade. Procedures such as transnasal esophagoscopy, site-specific steroid injections, injection laryngoplasty and laryngeal laser treatment can now be performed in the office setting under local anaesthesia. Although In-Office Laryngeal Procedures (IOLPs) have become standard-of-care in many American and several Canadian centers, there are no guidelines regulating the practice of these procedures. The goal of this report was to evaluate the current method of IOLP delivery in Canada.MethodsAn electronic survey was dispersed to 22 practicing Canadian laryngologists to assess safety and procedural care measures undertaken when performing IOLP. The survey consisted of 37 questions divided into 6 categories; 1) Demographic data 2) Facilities 3) Staff/personnel 4) Patient screening/monitoring 5) Procedure and emergency equipment 6) Reporting of adverse events.ResultsData was collected for 16/22 laryngologists (72.7% response rate). Only 1 respondent did not perform IOLP. All performed injection augmentation laryngoplasty. Most performed laryngeal biopsies, intramuscular injection and/or electromyography guided injection for the treatment of spasmodic dysphonia and glottic/subglottic steroid injections. Only 4 respondents performed in-office KTP laser. Significant variation was found in procedural processes including intra procedural monitoring, anticoagulation screening, access to emergency equipment and documentation.ConclusionOur survey demonstrates that the delivery of IOLP in Canada varies considerably. The construct of IOLP practice guidelines based on the evidence with consistent documentation would promote safe, efficient and quality care for patient with voice disorders.Electronic supplementary materialThe online version of this article (10.1186/s40463-018-0270-2) contains supplementary material, which is available to authorized users.

Is Continued Perioperative Antithrombotic Therapy Safe When Performing Direct Microlaryngoscopy?

“…In contrast, the majority answered that they would elect to temporarily discontinue use of warfarin (12/15; 80.0%) or clopidogrel (10/15; 66.7%) during the perioperative period. 16 The decision whether to continue direct oral anticoagulants such as dabigatran was the most polarizing, and perhaps related to decreased familiarity with such agents; 8/15 (53.5%) of those surveyed would choose to continue patients on these medications. 16 Despite these variations in clinical practice, a few small studies have suggested that preoperative discontinuation of antiplatelet and anticoagulation therapy may not be required for certain laryngology procedures.…”

Assessment and Treatment of Pain during In‐Office Otolaryngology Procedures: A Systematic Review

“…Performing procedures in the office instead of the operating room provides cost and time advantages and avoids general anesthesia, but success and patient-perceived quality through pain control and comfort depend on the provision of appropriate analgesia. [1][2][3]7,8 Accurate and relevant pain assessment is a critical initial step in successful pain control, but studies of postoperative pain have shown that these assessments are often woefully lacking. 12,101,102 In the era of quality-driven metrics and reimbursement, an important contributor is pain measurement, which has been shown to improve self-reported patient satisfaction and HCAHPS scores.…”

“…n-office or office-based procedures are common throughout the field of otolaryngology. [1][2][3] They possess advantages of convenience, cost, and efficiency over procedures performed in the operating room. [1][2][3] Improved technology has ensured in-office procedures are safe and effective.…”

“…[1][2][3] They possess advantages of convenience, cost, and efficiency over procedures performed in the operating room. [1][2][3] Improved technology has ensured in-office procedures are safe and effective. 1 Procedures done on awake, nonsedated patients require the provision of periprocedural pain management, and adequate pain control improves tolerance, procedural success, and patient satisfaction.…”

“…[1][2][3] Improved technology has ensured in-office procedures are safe and effective. 1 Procedures done on awake, nonsedated patients require the provision of periprocedural pain management, and adequate pain control improves tolerance, procedural success, and patient satisfaction. 4,5 Due to developing technology, cost considerations, and other advantages, the popularity of in-office procedures has grown.…”