Two Methods for Cidofovir Injection in the Office Procedure Room

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Two Methods for Cidofovir Injection in the Office
Procedure Room

• Robert W. Bastian, M.D.
• Bastian Voice Institute
• Downers Grove, IL

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When a new treatment arrives . . . It must be
given every chance to succeed . . .
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For cidofovir, that means we need to avoid . . .

• Failure due to inadequate dose
• Failure due to inadequate frequency
• Failure due to logistical barriers
• Convenience
• Cost
• Scheduling constraints

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Necessity for O.R. injection could limit
effectiveness of cidofovir . . .

• Cost
• Convenience
• Scheduling issues
• Patient aversion to general anesthesia
• Anatomical constraints jaw / neck

These things act as brakes to getting cidofovir
injections with reasonable frequency
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THEREFORE . . .

• Come out of the O.R. and into Office
• Videoendoscopy, not direct laryngoscopy
• Topical rather than general anesthesia (though
  with occasional sedation)
• Sitting rather than supine patient

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Indirect Larynx and Pharynx Surgery A
Replacement for Direct Laryngoscopy

• Bastian R and Delsupehe K LARYNGOSCOPE
  1061280-1286, 1996

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Indirect Laryngopharynx Surgery

• Cancer staging
• Cancer staging and biopsy
• Teflon, Gelfoam, Collagen injection for
  medialization
• Kenalog injection for granulation tissue
• Botox injection
• Cidofovir injection for papillomatosis
• Miscellaneous

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History Back to the Future

• Morrell Mackenzie mid to late 1800sinitial
  indirect biopsies were without topical anesthesia
• In the era before topical anesthesia, he had to
  train his patients to tolerance before he could
  accomplish the biopsy
• After cocaine was introduced, His failures were
  few and far between.

Indirect biopsy of Frederick Wilhelm III, Crown
Prince of Germany, 1887 and 1888
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What makes us all Morrell Mackenzie in 2004?

• Topical anesthetics
• Video technology endoscopes
• Patient interests (convenience, logistics)
• Physician interests (better care)
• Societal mandate to control costs

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Topical Anesthesia
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Equipment details
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(No Transcript)
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Telescopic
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Telescopic
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Fiberoptic
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Success or Complication Rate 192 Procedures

• Succeeded in single visit 184/ 192 (96)
• Two visits required 2/192 (1)
• UnsuccessfulG.A. needed 4/192 (2)
• Complication rate 0/192
• bleeding, laryngospasm, unplanned
  hospitalization, etc.

Biopsy and injections
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Benefits

• Efficient for Patient and Physician
• No risk of general anesthesia
• Low complication / failure rate
• Patient can drive themselves to and from the
  procedure, unless sedated
• Documentation easy
• Marked cost savings

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Video examples per-oral
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Video examples trans-cervical
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SUMMARY Office injections of cidofovir can
increase the chance of success by removing or
diminishing. . .

• Cost
• Inconvenience
• Scheduling issues
• Patient aversion to general anesthesia
• Anatomical constraints jaw / neck

These things act as brakes to getting cidofovir
injections with reasonable frequency