The 15° reverse Trendelenburg position can improve visualization without impacting cerebral oxygenation in endoscopic...

Area of Science:

• Otolaryngology
• Neurosurgery
• Anesthesiology

Background:

• Endoscopic sinus surgery (ESS) requires optimal visualization.
• The reverse Trendelenburg position (RTP) may improve surgical field conditions.
• The impact of RTP degree on intraoperative bleeding and cerebral oxygenation during ESS is not fully understood.

Purpose of the Study:

• To compare intraoperative bleeding and regional cerebral oxygenation (ScO2) in patients undergoing ESS at different degrees of RTP.
• To evaluate the safety and efficacy of RTP in improving surgical conditions.

Main Methods:

• 120 patients with chronic rhinosinusitis undergoing ESS were randomized into four groups: horizontal position (HP) and 5°, 10°, 15° RTP.
• Primary outcome: Boezaart grading scale (BS) for surgical field visualization.
• Secondary outcomes: ScO2, blood loss, pain (NRS), and complications were recorded.

Main Results:

• The 15° RTP group showed significantly better BS scores compared to HP, 5° RTP, and 10° RTP groups.
• The 15° RTP group had significantly lower bleeding rates and NRS scores compared to the HP group.
• No significant differences in ScO2 were observed among the groups, with no cerebral desaturation events.

Conclusions:

• The 15° RTP significantly enhances visual clarity during ESS.
• RTP degree does not adversely affect cerebral oxygenation (ScO2) or vital organ function.
• 15° RTP, combined with moderate deliberate hypotension, is recommended for ESS to improve surgical outcomes.