Bed angle adjustment to prevent extrajuglar vein stagnancy and reduce bleeding during endoscopic endonasal sinus surgery

概要

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Hypothesis : By placing the patient in a head-up position and adjusting the surgical bed to eliminate extrajuglar vein stagnancy, the venous pressure in the endonasal region is decreased during endoscopic endonasal sinus surgery (ESS). Method: Patients scheduled for ESS were assigned to either a fixed-position (head up, angle 5°) group (FP group, n = 22) or a variable adjustment group (VA group, n = 22), and compared for intraoperative blood loss. The VA group was placed at a bed angle at which the left extrajuglar vein collapsed during the expiratory phase under general anesthesia and mechanical ventilation with 2 cmH_2O of automatic positive end-expiratory pressure (PEEP). Results : The median bed angle was 5 degrees in the VA group, the same as in the FP group. Blood loss in the VA group was significantly lower than that of the FP group (p <0.05), but there was no significant correlation between the increase of the bed angle and the decrease of the intraoperative bleeding rate in the VA group. Conclusion: Adjustment of the bed angle to prevent extrajuglar vein stagnancy was effective for decreasing intraoperative blood loss in ESS.
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