European annals of otorhinolaryngology, head and neck diseases · 2025
Effect of 10 and 20 degrees reverse Trendelenburg position on surgical field quality during ear surgery. A randomized-controlled trial.
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El-Ozairy H S, Naguib M R, Abd-Elmaksoud A M, Mady O M
Аннотация
PURPOSE: Middle ear surgeries are better executed under controlled hypotension. Reverse-Trendelenburg (RTP) position has been used in endoscopic sinus surgeries as a safe and cost-free method to reduce intraoperative bleeding. However, it has not been tried in ear surgery due to surgical field accessibility concerns. The primary aim of this study was to evaluate the effect of two RTP angles (10 and 20 degrees) on quality of surgical field and surgical position accessibility.
METHODS: In total, 225 adult patients of both sexes, aged between 18 and 50years, ASA I-II, scheduled for elective middle ear surgery were enrolled in this randomized, prospective, controlled study. All patients were anesthetized using the same protocol. Patients were randomly and evenly allocated to one of three groups, 75 patients each; group I (control) patients were positioned supine, group II patients were positioned 10̊ RTP position and group III patients were positioned 20̊ RTP position. The surgeons were asked to assess the surgical field using a 5-point scale. The surgeon satisfaction concerning surgical position accessibility was evaluated using a 5-point scale. Total dexmedetomidine consumption, recovery time, surgical time and analgesia time were recorded.
RESULTS: The quality of surgical field was significantly different among the three groups (P-value<0.001), being best in group III. Surgeon's satisfaction score was found to be statistically insignificant among the three study groups (P-value=0.251).
CONCLUSION: This study showed that 10 and 20-degree RTP provided a significantly better surgical field quality without considerably affecting accessibility and decreased intraoperative dexmedetomidine consumption shortening the recovery time.
METHODS: In total, 225 adult patients of both sexes, aged between 18 and 50years, ASA I-II, scheduled for elective middle ear surgery were enrolled in this randomized, prospective, controlled study. All patients were anesthetized using the same protocol. Patients were randomly and evenly allocated to one of three groups, 75 patients each; group I (control) patients were positioned supine, group II patients were positioned 10̊ RTP position and group III patients were positioned 20̊ RTP position. The surgeons were asked to assess the surgical field using a 5-point scale. The surgeon satisfaction concerning surgical position accessibility was evaluated using a 5-point scale. Total dexmedetomidine consumption, recovery time, surgical time and analgesia time were recorded.
RESULTS: The quality of surgical field was significantly different among the three groups (P-value<0.001), being best in group III. Surgeon's satisfaction score was found to be statistically insignificant among the three study groups (P-value=0.251).
CONCLUSION: This study showed that 10 and 20-degree RTP provided a significantly better surgical field quality without considerably affecting accessibility and decreased intraoperative dexmedetomidine consumption shortening the recovery time.