impact of reverse trendelenburg versus head-up position on intraoperative bleeding of elective rhinoplasty

In spite of several efforts for decreasing blood loss, our experience sometimes shows that some patients bleed more profusely during rhinoplasty. Patient position could have deep impact on bleeding amount during surgical procedures. In this study, we aimed to compare reverse trendelenburg position and head-up position on intra-operative bleeding of elective rhinoplasty. This was to check the effects of reverse trendelenburg position and head up position on the intraoperative bleeding of elective rhinoplasty. In this study, 30 ASA I [American Society of Anesthesiology physical condition classification] patients between 18 and 40 years of age who were candidate to rhinoplasty operations for first time were included. Patients were randomly assigned to reverse trendelenburg or head-up position. Exclusion criteria was any history or lab indicating coagulation problems or using any drug. All gauzes used and the blood that accumulated in the aspirator throughout the operation were calculated. Our results showed that the mean amount of blood loss in reverse trendelenburg was lower [77.00 +/- 13.20 ml] than head up position [83.33 +/- 21.18 ml], although, there was no statistical difference between two groups. However, there was no significant differences among two groups in different aspects of hemodynamic determinants and bleeding amount during and after rhinoplasty. Our results showed that patient bleeding is not increased because of positioning per se. In conclusion, perhaps in the future reverse trendelenburg will be given more often during rhinoplasry

Preoperative assessment of mechanical ventilation requirement after surgical treatment of esophageal cancer

The risk of pulmonary complications after esophagectomy is higher than after any other common operation, including major lung resection. In this study, we sought to identify risk factors associated with the development of pulmonary insufficiency requiring mechanical ventilation to identify preoperative parameters involved in the estimation of the risk of pulmonary insufficiency. We performed a retrospective cohort study on consecutive patients undergoing esophagectomy for malignancy in the Thoracic Surgery Department of Modarres Hospital in Tehran from March 2002 to February 2006. Patients were assigned into two groups based on whether they required mechanical ventilation or not. Preoperative, operative, and postoperative data were compared among the two groups. To find predictive variables for requiring mechanical ventilation, backward stepwise regression analysis was carried out with risk factors as independent variables and the need for ventilatory support as the dependent variable. The study population included 77 males and 43 females with a mean age of 60.16 +/- 12.04 years [range 29-79 years]. Twenty-seven patients [27.7%] required mechanical ventilatory support. Multivariate analysis revealed sex [Odds ratio: 4.590, Cl 95%: 1.246-16.411] as a confounder and duration of operation [Odds Ratio: 1.677, Cl95%: 1.102-2.533] as a risk factor for requiring mechanical ventilation. Proper patient selection for esophagectomy is important for reducing the postoperative mortality and morbidity and benefiting from a radical resection