Safety of Direct Laryngoscopy As an Outpatient Procedure

Abstract

The safety of outpatient direct laryngoscopy has recently been challenged in the literature. We reviewed the first 589 direct laryngoscopies performed at a new outpatient surgery center. There were nine unplanned admissions to the hospital, including five airway emergencies that developed within the first 30 min after extubation. Three patients required reintubation before leaving the operating room. On postoperative telephone follow-up, 9% complained of mild to moderate sore throat. There were no major complications after discharge. We conclude that the risk of airway emergencies after direct laryngoscopy is less than 1% in carefully selected patients. The procedure can be safely performed as an outpatient procedure as long as transportation to a hospital is readily available for the few patients in whom complications arise.

Safety of Adult Ambulatory Direct Laryngoscopy

“…Armstrong et al 17 studied 692 outpatient endoscopies (including 589 direct laryngoscopies) and found a less than a 1% risk of airway emergencies in carefully selected patients. Their study 17 reported 10 unplanned admissions and 7 major complications. Cancer and laryngeal biopsies significantly increased the risk of complications, but Armstrong et al 17 cautioned that the surgeon was the best judge of the need for inpatient admission.…”

“…Common reasons for planned admission included large laryngeal tumors, vocal fold motion dysfunction, and laryngeal stenosis requiring stent placement. 17 Despite the relatively rapid evolution of ambulatory laryngeal surgery with advanced techniques, relatively few studies have examined the ongoing safety profile of these procedures. The revisit rate was similar across the first 7 postoperative days.…”

Anaesthesia for direct laryngoscopy with propofol and fentanyl or sufentanil

“…were discharged the same day. The chief serious complications after laryngoscopy are airway collapse, the incidence of which is less than 1% [12]. None of the patients in any group had serious postoperative complications.…”

Ambulatory Laryngopharyngeal Surgery

“…This number compares well with the previously reported rates of unplanned admission after laryngoscopy, which range from 0 to 3%. 6,8,[18][19][20][21] In the literature, minor complications after laryngoscopy include dental and mucosal injuries, neuralgias, and dysphagia, with rates of up to 75%. [20][21][22] Unfortunately, these minor complications were not reported in the NSAS survey and may represent some of the "other" complications listed.…”

“…In fact, the safety of rigid endoscopy performed with the patient under general anesthesia was debated during the 1990s. [6][7][8] Up to this point, the safety of rigid endoscopy was established through single institutional experiences, with drastically varied reports of complication and unexpected admission rates after surgery. In an effort to answer the questions regarding how many ambulatory laryngopharyngeal surgeries are performed in the operating room as well as the perioperative outcomes of these procedures, the National Survey of Ambulatory Surgery (NSAS) was queried.…”