All patients are formally consented for the procedure, during which time all poten­tial risks and complications, including intra- and post-procedure epistaxis, syncope, risk of infection, possibility of recurrence, possibility of cardiac events, etc., are explained.

Patients are positioned on an operating room bed in a sitting position at approxi­mately 60–70 degrees of head elevation. Patients are advised to wear light clothing and all heavy jackets and sweaters are removed. The front of the patient is covered with a towel around the neck and a blue pad so as not to soil their clothes. Pulse oximetry is continually monitored prior to, during and after the procedure. The setup is similar to the operating room, in that the surgeon stands on the right side of the patient while the endoscopic tower is positioned on the left side of the patient and directly facing the operating surgeon in an ergonomically favorable position. Two suctions are available where one is connected to the microdebrider and the second one is connected to a yankauer tip which is given to the patient so that all blood, saline, and debris can be easily expectorated per orally by the patient through­out the procedure. A second monitor is positioned across from the patient so that patients who want to watch the procedure can do so. We have noticed that patients who view their procedure often get distracted and handle the procedure much better than those who don’t.

The microdebrider is ideally set at 3000 rotations per minute (RPM) and in the XPS mode. We nd that the XPS mode allows better control of the debrider blade for the surgeon. Ten minutes prior to the beginning of the procedure, 5ml of a mix­ture of 4% topical lidocaine and 0.05% of oxymetazoline is sprayed into both nos­trils using a mucosal atomization device (MAD). This allows for topical decongestion and anesthesia for the sinonasal mucosa. Subsequently, one to two 0.05% oxy­metazoline/4% lidocaine soaked neuropatties are gently placed into each nostril. The authors avoid the use of injections containing epinephrine as they can lead to reex tachycardia and increases in blood pressure, which can further lead to increased bleeding and anxiety [6]. At this point, the patient is considered ready to undergo an in-ofce polypectomy.

There have been multiple publications examining outpatient polypectomy out­comes. A recent publication by Viera-Artiles etal. on 44 patients showed a 64% reduction in SNOT-22 scores with one patient experiencing severe bradycardia and bradypnea [7]. We have reported our published results [8] on a total of 68 patients who received ofce-based polypectomy, with a mean age of 49years. There was an equal distribution of males and females (Table15.1). Fifty-three patients (78%) had previously received FESS. Twenty-one patients (31%) had previously received both FESS and an ofce-based polypectomy. Ofce polypectomies were selected for