Evaluation of Oxygenation Parameters in Patients Undergoing Rhinoplasty Under General Anesthesia

Study Overview
=================
Brief Summary
-----------------
The investigators are planning to compare the oxygenation values (Pao2/fio2, lactate etc.) in patients who underwent TCI and inhalation anesthesia in rhinoplasty operation.

Detailed Description
-----------------
Total intravenous anesthesia (TIVA) is a common anesthesia method used today as an alternative to inhalation anesthesia. Loss of consciousness is two important components of general anesthesia, in order to give the patient safe analgesia and not to remember any adverse events related to the operation. While the depth of anesthesia can be controlled by monitoring the minimum alveolar concentration (MAK) in the ventilator devices in the operating room we use modernly, there was no more objective method than measuring the plasma level of drugs in intravenous anesthesia. The schemes created by the anesthetists according to plasma drug levels were used when administering total intravenous anesthesia. Target Controlled Anesthesia (TCI) devices, on the other hand, are pumps that have been used more frequently recently and that can deliver the required blood concentration of a drug in bolus and infusion form according to pharmacokinetics models calculated with personal data. In TCI anesthesia, intravenous infusion of anesthetics provides a more stable drug concentration in the plasma and at the site of action compared to repeated bolus techniques. Thus, it is ensured that the drug remains in the therapeutic range, avoiding the consequences such as over- or under-administration of the drugs. The subject of the study is to determine which of the 2 routinely used methods in rhinoplasty operations affects respiratory functions less.

Official Title
-----------------
Evaluation of Oxygenation Parameters in Patients Undergoing Rhinoplasty Under General Anesthesia

Conditions
-----------------
Anesthesia; Functional

Intervention / Treatment
-----------------
* Procedure: target controlled infusion (TCI) group


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients older than 18 years and younger than 60 years of age who will be operated under general anesthesia Patients in I, II risk groups according to the American Society of Anesthesiologists (ASA) classification Exclusion Criteria: ASA III and above patients Patients for whom Intensive Care Unit (ICU) indication is prescribed Chronic obstructive pulmonary disease Having a personal or family history of malignant hyperthermia, morbid obesity Alcohol or drug addiction Have a history of liver or kidney disease Coronary artery disease or heart failure Anemia Hemoglobinopathy Sepsis

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| target controlled infusion (TCI) group<br>Propofol and remifentanil will be used in TCI anesthesia, and while the patient is under adequate sedation (BIS40-60), muscle relaxation will be provided with 0.6 mg/kg rocurium bromide. While applying TCI anesthesia, the device will use the Minto model for Remifentanil infusion and the Schnider model for Propofol infusion. | Procedure: target controlled infusion (TCI) group<br>* Patients in the TCI group will be anesthetized with propofol and remifentanil throughout the operation. Patients included in the inhalation anesthesia group will be anesthetized with desflurane and remifentanil with a bispectral index of 40-60 throughout the operation.<br>* Other names: inhalation anesthesia (IA) group;|
| inhalation anesthesia (IA) groups<br>During anesthesia induction of patients receiving inhalation anesthesia, 60 mg 2% lidocaine, 2 mg/kg propofol, 0.6 mg/kg rocuronium bromide and 1 mcg/kg fentanyl will be used. Desflurane will be used with a minimum alveolar concentration of 1 and for additional intraoperative sedation. remifentanil will be given between 0.05 and 0.2mcg/kg/min according to the patient's needs. | Procedure: target controlled infusion (TCI) group<br>* Patients in the TCI group will be anesthetized with propofol and remifentanil throughout the operation. Patients included in the inhalation anesthesia group will be anesthetized with desflurane and remifentanil with a bispectral index of 40-60 throughout the operation.<br>* Other names: inhalation anesthesia (IA) group;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| oxygen concentration change throughout the operation | In both general anesthesia methods, blood gas measurements will be made at certain intervals, and pao2 /fio2 in percent (%) ratio will be recorded. | 6 periods; 0. basal blood gas(preoperation), 5 min after intubation, 2 hours after intubation, 5 minutes before extubation, 8 hours after extubation | 
| tissue oxygen use as lactate change throughout the operation | In both general anesthesia methods, blood gas measurements will be made at certain intervals serum lactat values mg/dl ratio will be recorded. | 6 periods; 0. basal blood gas(preoperation), 5 min after intubation, 2 hours after intubation, 5 minutes before extubation, 8hours after extubation | 
| airway pressures throughout the operation | Airway pressures in cmH2O will be recorded during both anesthesia methods applied throughout the operation. | during the operation | 
| lung compliance throughout the operation | The lung compliance in in ml/cmH2O will be recorded during both anesthesia methods applied throughout the operation. | during the operation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nausea | Postoperative nausea, vomiting, recovery time from anesthesia will be recorded. | Postoperative 24 hour | 
| vomiting | Postoperative vomiting, recovery time from anesthesia will be recorded. | Postoperative 24. hour | 
| recovery time | Postoperative recovery time from anesthesia will be recorded. | Postoperative 24 hour | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
target controlled anesthesia, oxygenation, inhalation anesthesia