The physiologic impact of transnasal flexible endoscopy

Objectives/Hypothesis: Diagnostic transnasal flexible endoscopy (TNFE) is a commonly used office procedure in otolaryngology. Currently there is a paucity of data on the impact of TNFE on physiologic parameters. This is relevant with the advent of office-based endoscopic procedures. The goal of this study is to measure the impact of topical decongestion, anesthesia, and diagnostic TNFE on vital signs: systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), and oxygenation (O2 sat). Study Design: Prospective case control study, in which the patient is his/her control. Methods: Vital signs were obtained at baseline, immediately after the application of Neosynephrine, after the application of lidocaine, 5 minutes later, with the scope in the nasopharynx and hypopharynx, and upon completion of the procedure. Results: Compared to the baseline data, there was a statistically significant increase in HR after the procedure (mean change, 4.06 +/- 10.15 bpm; range, -14 to 42 bpm, P = .01). There was also a change in O2 sat (mean change, 0.42% +/- 1.36%; range -3% to 3%, P = .03) after the application of lidocaine. When comparing each data point to the preceding point, there was a statistically significant change in SBP with the scope in the nasopharynx (mean change, 5.34 +/- 10.65 mm Hg; range, -22 to 28 mm Hg, P = .001) and in HR with the scope in the hypopharynx (mean change, 3.76 +/- 6.41 bpm; range, -9 to 19 bpm, P = .0004). Conclusions: Diagnostic TNFE and topical lidocaine can have an impact on physiologic parameters; however, these changes are unlikely to be clinically significant.