An interventional study of The amount of intraoperative bleeding and Quality of the intraoperative surgical field in Anesthesia, Carbon Dioxide and Surgical Blood Loss, sponsored by Bezmialem Vakif University. Completed at 1 site in Turkey. Open to participants aged 18 Years to 65 Years. Per ClinicalTrials.gov, last updated 2023-02-06.
Sponsored by Bezmialem Vakif University · Not applicable, Interventional, and Treatment
It is unknown whether different end-tidal carbon dioxide pressure levels have a clinically significant effect on bleeding and surgical field quality in septorhinoplasty, especially during controlled hypotension. Therefore, it was aimed to investigate the effect of ventilation strategy with controlled hypocapnia on intraoperative bleeding and surgical field quality for commonly practiced in septorhinoplasty.
Septorhinoplasty is one of the most common esthetic surgeries in the world. The septorhinoplasty is accompanied by insignificant bleeding on the surgical field. Excessive bleeding compromises the surgical field quality and makes more difficult the septorhinoplasty. It is very important to control and minimize excessive bleeding in surgical field by different approaches of anesthesia management. Successful approaches to reduce the excessive bleeding are; controlled hypotension by keeping the mean arterial pressure in the range of 60-70 mmHg, the reverse Trendelenburg position of the patient, administration of adrenaline (injection prior to surgery or packing soaked during surgery), and administration of tranexamic acid, which are applicable methods in many clinical centers.
Cardiac output may vary depending on the autonomic nervous system. The dominance of parasympathetic system effect may cause vasodilation, decrease in blood pressure and cardiac output. This vasodilation may increase bleeding during septorhinoplasty and worsen the surgical field quality. Anesthesia management may provide a clear view for the surgeon and an improved surgical field quality. The effect of carbon dioxide on vascular reactivity deserves an extra attention in septorhinoplasty required bleeding control. The intensity of bleeding in septorhinoplasty is mainly affected by mean arterial pressure and heart rate. At the same time, blood flow can be affected directly by carbon dioxide on the smooth muscular tonus of the arterioles.
After all, it is unknown whether different carbon dioxide pressure levels have a clinically significant effect on bleeding and surgical field quality in septorhinoplasty, especially during controlled hypotension. Therefore, it was aimed to investigate the effect of ventilation strategy with controlled hypocapnia on intraoperative bleeding and surgical field quality for commonly practiced in septorhinoplasty.
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Exclusion Criteria:
End-tidal carbon dioxide level will be 30±2 mmHg in the capnography, and the respiratory rate will be 14-20/minutes in the hypocapnia group.
Diagnostic Test: The amount of intraoperative bleeding · Diagnostic Test: Quality of the intraoperative surgical field · Diagnostic Test: Surgeon Satisfaction · Diagnostic Test: Heart rate · Diagnostic Test: Mean arterial pressure · Diagnostic Test: Peripheral oxygen saturation
End-tidal carbon dioxide level will be 40±2 mmHg in the capnography, and the respiratory rate will be 10-14/minutes in the hypercapnia group.
Diagnostic Test: The amount of intraoperative bleeding · Diagnostic Test: Quality of the intraoperative surgical field · Diagnostic Test: Surgeon Satisfaction · Diagnostic Test: Heart rate · Diagnostic Test: Mean arterial pressure · Diagnostic Test: Peripheral oxygen saturation
Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.
Also known as: Intraoperative bleeding
Quality of the intraoperative surgical field will be measured on a grade of 0-10 (0-1. no bleeding, 2-3. mild bleeding, 4-5. Mild to moderate bleeding, 6-7. moderate bleeding, 8-9. moderate to severe bleeding, 10. Severe bleeding)
Also known as: Quality of the surgical field
Surgeon Satisfaction will be measured on a grade of 0-5 (1= very bad, 2= bad, 3= moderate, 4= good, 5= very good).
From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
Total amount of intraoperative bleeding
Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.
Time frame: From beginning of surgery to end of surgery
Quality of the intraoperative surgical field
Quality of the intraoperative surgical field will be measured on a grade of 0-10 (0-1. no bleeding, 2-3. mild bleeding, 4-5. Mild to moderate bleeding, 6-7. moderate bleeding, 8-9. moderate to severe bleeding, 10. Severe bleeding)
Time frame: Quality of the intraoperative surgical field will be performed to surgeon 30 minutes after the procedure
Surgeon Satisfaction
Surgeon Satisfaction will be measured on a grade of 0-5 (1= very bad, 2= bad, 3= moderate, 4= good, 5= very good).
Time frame: Surgeon Satisfaction will be performed to surgeon 30 minutes after the procedure
Heart rate
Heart rate is measured as beats/minute on the anesthesia monitor
Time frame: From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
Mean arterial pressure
Mean arterial pressure is measured as mmHg on the anesthesia monitor
Time frame: From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
Peripheral oxygen saturation
Peripheral oxygen saturation is measured as percentage (%) on the anesthesia monitor
Time frame: From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)
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Bezmialem Vakif University