title: The Effect of Patient Positioning on Amount of Intraoperative Bleeding in Rhinoplasty: A Randomized Controlled Trial.
abstract: BACKGROUND
  There is a rich blood flow to the mucosa in the nasal region. In rhinoplasty, surgical procedures are performed in a narrow and confined space. So bleeding during surgery reduces visibility which can complicate the procedure. This study investigated the effects of the patient position on amount of intraoperative bleeding during surgical procedures.
  
  
  METHODS
  This randomized controlled trial was conducted on 71 patients who underwent elective rhinoplasty. The patients were operated on in three groups. Group 1 consisted of 23 patients who were operated on in the supine position; Group 2 included 28 patients who were operated on using a 15° angle reverse Trendelenburg position; Group 3 consisted of 20 patients who were operated on at a 20° angle reverse Trendelenburg position.
  
  
  RESULTS
  There were statistically significant differences between the groups in regard to surgeon satisfaction and the amount of intraoperative bleeding. The amount of intraoperative bleeding in Group 1 was significantly higher than those of Groups 2 and 3, and surgeon satisfaction was lower.
  
  
  CONCLUSIONS
  Reverse Trendelenburg position reduces intraoperative bleeding in rhinoplasty patients while facilitating the procedure compared to the supine position. Surgery at a 15° angle reverse Trendelenburg position provides the optimum working conditions by both significantly reducing intraoperative bleeding and allowing for comfortable conditions for the surgeon.
  
  
  METHODS
  This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
authors.affiliation: SO-EP Aesthetic & Plastic Surgery Clinic, Seyitgazi Mah. Seyyid Burhaneddin Bulv. No:51/A, 38050, Kayseri, Turkey. m.ozkose@hotmail.com.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozkose
authors.affiliation: Kayseri State Hospital, Kayseri, Turkey.
authors.forename: Halit
authors.initials: H
authors.lastname: Baykan
authors.affiliation: Department of Anesthesiology and Reanimation, Faculty of Medicine, K.S.Ü, Kahramanmaras, Turkey.
authors.forename: İsmail
authors.initials: İ
authors.lastname: Coşkuner
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000503:physiopathology*; D017558:Elective Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D018475:Head-Down Tilt; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000009:adverse effects / Q000379:methods*; D012225:Rhinoplasty / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Body position; Hypotensive anesthesia; Intraoperative bleeding; Reverse Trendelenburg position; Rhinoplasty; Surgeon satisfaction