EtCO2 Level to Control Intraoperative Bleeding and Improve the Quality of Surgical Field Vision in Septorhinoplasty

NCT ID: NCT05497375

Last Updated: 2023-02-06

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

70 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-08-20

Study Completion Date

2022-11-15

Brief Summary

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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

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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.

Conditions

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Anesthesia Carbon Dioxide Surgical Blood Loss

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Participants

Study Groups

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Group Hypocapnia

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.

Group Type ACTIVE_COMPARATOR

The amount of intraoperative bleeding

Intervention Type DIAGNOSTIC_TEST

Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.

Quality of the intraoperative surgical field

Intervention Type DIAGNOSTIC_TEST

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

Intervention Type DIAGNOSTIC_TEST

Surgeon Satisfaction will be measured on a grade of 0-5 (1= very bad, 2= bad, 3= moderate, 4= good, 5= very good).

Heart rate

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Mean arterial pressure

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Peripheral oxygen saturation

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Group Hypercapnia

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.

Group Type ACTIVE_COMPARATOR

The amount of intraoperative bleeding

Intervention Type DIAGNOSTIC_TEST

Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.

Quality of the intraoperative surgical field

Intervention Type DIAGNOSTIC_TEST

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

Intervention Type DIAGNOSTIC_TEST

Surgeon Satisfaction will be measured on a grade of 0-5 (1= very bad, 2= bad, 3= moderate, 4= good, 5= very good).

Heart rate

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Mean arterial pressure

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Peripheral oxygen saturation

Intervention Type DIAGNOSTIC_TEST

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Interventions

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The amount of intraoperative bleeding

Total amount of intraoperative bleeding will be calculated in milliliters after the end of surgery.

Intervention Type DIAGNOSTIC_TEST

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)

Intervention Type DIAGNOSTIC_TEST

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).

Intervention Type DIAGNOSTIC_TEST

Heart rate

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Intervention Type DIAGNOSTIC_TEST

Mean arterial pressure

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Intervention Type DIAGNOSTIC_TEST

Peripheral oxygen saturation

From beginning of Anesthesia induction to the end of anesthesia (during perioperative period)

Intervention Type DIAGNOSTIC_TEST

Other Intervention Names

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Intraoperative bleeding Quality of the surgical field

Eligibility Criteria

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Inclusion Criteria

* American Society of Anesthesiologists scores 1-3
* 18-65 years

Exclusion Criteria

* American Society of Anesthesiologists scores IV,
* Under the age of 18,
* Over the age of 65,
* Using anticoagulant and antiplatelet drugs,
* Previous underwent septorhinoplasty operation,
* Obstetric conditions,
* Cardiovascular and pulmonary disease,
* Uncontrolled cerebrovascular disease,
* Allergic history to propofol, fentanyl, rocuronium, paracetamol, ibuprofen and tramadol,
* Refused written informed consent
Minimum Eligible Age

18 Years

Maximum Eligible Age

65 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bezmialem Vakif University

OTHER

Sponsor Role lead

Responsible Party

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Muhittin Calim

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Muhittin Calim, MD

Role: PRINCIPAL_INVESTIGATOR

Bezmialem Vakif University

Locations

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Muhittin Calim

Istanbul, Fatih, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Eftekharian HR, Rajabzadeh Z. The Efficacy of Preoperative Oral Tranexamic Acid on Intraoperative Bleeding During Rhinoplasty. J Craniofac Surg. 2016 Jan;27(1):97-100. doi: 10.1097/SCS.0000000000002273.

Reference Type BACKGROUND
PMID: 26674898 (View on PubMed)

Other Identifiers

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muhittincalim3

Identifier Type: -

Identifier Source: org_study_id

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