Evaluating the Effect of Pressure-Controlled Versus Volume-Controlled Ventilation Modes on Intraoperative Bleeding in...

Area of Science:

• Anesthesiology
• Plastic Surgery
• Surgical Innovation

Background:

• Intraoperative bleeding presents a significant challenge in rhinoplasty procedures.
• Effective bleeding management is crucial for surgical success and patient safety.

Purpose of the Study:

• To compare the efficacy of pressure-controlled ventilation (PCV) against volume-controlled ventilation (VCV) in minimizing intraoperative bleeding during rhinoplasty.
• To identify the optimal ventilation strategy for reducing blood loss in this specific surgical context.

Main Methods:

• A double-blinded randomized clinical trial involving 58 rhinoplasty candidates.
• Patients were allocated to either PCV or VCV groups, with anesthesia maintained via total intravenous anesthesia (TIVA).
• Bleeding was quantified using blood-soaked gauze, suctioned fluid volume, and the Boezaart criterion for surgical field assessment.

Main Results:

• Mean intraoperative bleeding was substantially lower in the PCV group (30 ± 45 mL) compared to the VCV group (100 ± 120 mL) (P < 0.001).
• Logistic regression revealed a 5.4-fold higher risk of moderate to severe bleeding in the VCV group, increasing to 26.8 after adjusting for confounders.
• PCV demonstrated a significant reduction in intraoperative blood loss.

Conclusions:

• Pressure-controlled ventilation (PCV) is associated with reduced intraoperative bleeding in rhinoplasty compared to volume-controlled ventilation (VCV).
• The observed decrease in peak airway pressure during PCV may contribute to the reduction in bleeding.
• PCV represents a potentially safer ventilation strategy for rhinoplasty, minimizing surgical bleeding.