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Int J Prev Med. 2013 Dec;4(12):1438-41.

The Impact of Reverse Trendelenburg Versus Head-up Position on Intraoperative Bleeding of Elective Rhinoplasty.

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Anesthesiology Research Center, Department of Anesthesiology, Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Chronic Respiratory Disease Research Center (CRDRC), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences (SBMU), Tehran, Iran.



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.


Intraoperative bleeding; reverse trendelenburg; rhinoplasty

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