The prevention of postoperative shock and postanesthesia hypotension by use of the reverse Trendelenburg position during surgery under light, etherless, general anesthesia

Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double-blind randomized controlled trial

BACKGROUND

Using the reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery (FESS) is a safe, simple, and cost-free method that has been found to reduce intraoperative blood loss. However, the critical angle of RTP that produces the least amount of bleeding without compromising surgical technique and safety remains unanswered. The objective of this study was to assess the effects of 5-degree, 10-degree, and 20-degree RTP (5-RTP, 10-RTP, and 20-RTP, respectively) on intraoperative bleeding during FESS.

METHODS

This double-blind randomized controlled trial involved 75 patients with chronic rhinosinusitis (CRS) with and without nasal polyposis undergoing FESS. Twenty-five patients were enrolled into each group: 5-RTP, 10-RTP, and 20-RTP. Boezaart endoscopic field-of-view score (BS), total blood loss (TBL), mean arterial blood pressure (MABP), operating time, and blood loss per minute were recorded. An intention-to-treat analysis was used, with a Bonferroni adjustment for multiple comparisons.

RESULTS

Intervention groups were comparable in age, sex, nasal polyposis, and disease severity. Mean values of BS and TBL were as follows: 5-RTP (2.0, 231 mL), 10-RTP (1.8, 230 mL), and 20-RTP (1.4, 135 mL). The differences in means were significant for BS (p < 0.01) and TBL (p = 0.03). There was no significant difference in MABP (p = 0.85), operating time (p = 0.10), or blood loss per minute (p = 0.11) between the 3 groups. Pairwise comparison between 5-RTP vs 20-RTP found significant difference in BS (p < 0.01) but not TBL (p = 0.04). Significance was not found in similar comparisons of 10-RTP vs 20-RTP and 5-RTP vs 10-RTP (p > 0.03).

CONCLUSION

FESS in 20-RTP produced the best BS and lowest blood loss without compromising surgical technique.

Multiple analyses of factors related to intraoperative blood loss and the role of reverse Trendelenburg position in endoscopic sinus surgery

OBJECTIVE/HYPOTHESIS

To find out the factors related to the volume of intraoperative blood loss during endoscopic sinus surgery and to validate the role of reverse Trendelenburg position (RTP) in controlling blood loss.

STUDY DESIGN

Prospective, controlled, single-blind study.

METHODS

Endoscopic sinus surgeries for chronic rhinosinusitis with or without polyposis were performed in 60 patients, which were randomly categorized into two groups. The study group (RTP group) consisted of 30 patients laid on operation table with the RTP of 10 degrees during the whole surgery, and the control group with 30 patients completely laid supine. All operations were performed by the same operator (the first author) without using hemostatic agents during the operation. Intraoperative blood loss was estimated by total volume of blood loss, blood loss per minute, and surgical field scale. Multiple factors related to blood loss, such as computed tomography scores, operation time, mean arterial pressure, polyposis, fungal sinusitis, and anesthetic agents were compared.

RESULTS

There existed significant differences in total blood loss, blood loss per minute, and surgical field between the RTP group and supine group. In multiple analyses within the two groups, presence of polyp, non-fungal sinusitis and use of microdebrider exhibited a significant higher blood loss rate in the RTP group.

CONCLUSION

RTP may reduce intraoperative blood loss. Besides, fungal sinusitis and rhinosinusitis without polyposis may contribute to a lesser intraoperative blood loss.