Effects of five degree, 10-degree and 20-degree reverse trandelenburg position on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty

Aim: Edema and ecchymosis around the eyes, which can often be seen after cosmetic or functional open rhinoplasty operations, are not only a cosmetic problem, but can also pave the way for postoperative pain and infection. In addition, a bloodless operation area by minimizing the bleeding in the operation area in the intraoperative period in open rhinoplasty surgeries is also very important in terms of surgeon satisfaction. Many pharmacological and non-pharmacological methods have been used to reduce edema and ecchymosis around the eyes in the postoperative period and to provide a blood-free operation field in the intraoperative period. In this study, we investigated the effect of a non-pharmacological method of reverse trandelenburg position (TTP) of five, ten and twenty degrees on intraoperative bleeding and postoperative edema and ecchymosis around the eye in open rhinoplasty operations. Material and Methods: The study was performed in 90 patients in the ASA I-II group, aged 18-40, who will undergo open rhinoplasty by plastic surgery after the approval of the Local Ethics Committee and patient consent. After the preoperative anesthetic evaluation, the study was explained to the patients in detail and their verbal and written consents were obtained. The study groups were determined as Group 5 (n = 30) with five degrees of TTP on the operation table, Group 10 (n = 30) with ten degrees of TTP, and Group 20 (n = 30) with 20 degrees of TTP. By performing routine anesthesia monitoring, ECG, non-invasive systolic, diastolic and mean arterial pressures, peripheral saturation and end-respiratory carbon dioxide (EtCO2) values of the patients were recorded. Intraoperative bleeding amount and surgical field evaluation scores were recorded. On the postoperative 1st, 3rd and 7th days, edema and ecchymoses around the eyes of the patients were evaluated in a digital environment. Results: There was no significant difference between the groups in terms of ASA risk scores, age, gender, weight, height, BMI and operation time. There was no significant difference between the groups in terms of intraoperative mean arterial pressure, heart rate, systolic blood pressure, diastolic blood pressure and SPO2 values. EtCO₂ changes of the groups, surgical incision, and the EtCO₂ values at the 5th and 15th minutes after surgical incision were found to be significantly higher in Group 10 compared to Group 20. In addition, the EtCO₂ values at the 5th and 10th minutes after surgical incision and surgical incision were found to be significantly higher in Group 5 compared to Group 20. Edema changes around the eyes in the postoperative 1st, 3rd and 7th days of the groups were found to be significantly lower in Group 20 compared to Group 5. In addition, on the postoperative 7th day, it was found to be significantly lower in Group 20 compared to Group 10. The changes of ecchymosis around the eyes on postoperative 1st and 3rd days of the groups were found to be significantly lower in Group 20 compared to Group 5. In addition, it was found to be significantly lower in Group 20 compared to Group 10 on the postoperative 1st day. The amount of intraoperative bleeding was found to be significantly lower in Group 10 and Group 20 compared to Group 5. In addition, the surgical field evaluation score in Group 10 and Group 20 were found to be significantly lower than Group 5. Conclusion: In open rhinoplasty surgeries, we concluded that 20 degree TTP reduces intraoperative blood loss and provides a more bloodless operation area, as well as reducing edema and ecchymoses around the eyes in the postoperative period.