EtCO2 Level to Control Intraoperative Bleeding and Improve the Quality of Surgical Field Vision in Septorhinoplasty
Condition: Anesthesia; Carbon Dioxide; Surgical Blood Loss
MeSH terms: Hemorrhage; Blood Loss, Surgical
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): The amount of intraoperative bleeding; Quality of the intraoperative surgical field; Surgeon Satisfaction; Heart rate; Mean arterial pressure; Peripheral oxygen saturation
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.; 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); 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)
Other intervention name(s): Intraoperative bleeding; Quality of the surgical field
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Anesthesia management; Ent-tidal carbon dioxide; Bleeding; Quality of surgical field