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Processed EEG Monitoring During Controlled Hypotension in Patients Undergoing Rhinoplasty
Observational Evaluation of the Relationship Between Intraoperative Processed EEG Monitoring,Surgical Bleeding and Recovery Quality in Patients Undergoing Rhinoplasty Under Controlled Hypotension
Studie Overzicht
Toestand
Gedetailleerde beschrijving
Controlled hypotension is commonly used during rhinoplasty to improve surgical field visibility and reduce bleeding. However, the adequacy and safety of controlled hypotension should not be evaluated only by hemodynamic variables. Processed EEG monitoring may provide additional information about hypnotic depth and the probability of response to nociceptive stimulation.
In this prospective observational study, adult patients undergoing elective rhinoplasty under general anesthesia were monitored with standard ASA monitoring and processed EEG monitoring. Total intravenous anesthesia was maintained with propofol and remifentanil. Esmolol infusion was used as part of the controlled hypotension strategy. Intraoperative qCON and qNOX values, hemodynamic parameters, surgical bleeding scores, anesthetic drug consumption, extubation time, time to reach Aldrete score ≥9, and early postoperative cognitive recovery were recorded.
The primary objective is to evaluate the intraoperative course of qCON and qNOX values during controlled hypotension. Secondary objectives are to assess the relationship of processed EEG parameters with recovery quality, early postoperative cognitive status, anesthetic drug consumption, and surgical field bleeding.
Studietype
Inschrijving (Werkelijk)
Contacten en locaties
Studie Locaties
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Ankara, Turkije (Türkiye)
- Gazi University
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Deelname Criteria
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
- Volwassen
- Oudere volwassene
Accepteert gezonde vrijwilligers
Bemonsteringsmethode
Studie Bevolking
Beschrijving
Inclusion Criteria:
- Patients aged 18 years or older
- Patients scheduled for elective rhinoplasty
- Patients classified as ASA physical status I-II
- Patients planned to undergo general anesthesia with total intravenous anesthesia
- Patients in whom frontal processed EEG electrodes can be applied
- Patients who provide written informed consent
Exclusion Criteria:
- Emergency surgery
- Severe neurological disease
- Scalp lesion or marked dermatitis preventing processed EEG electrode placement
- Communication or hearing impairment preventing postoperative assessment
- Marked hemodynamic instability
- Multiple trauma or need for postoperative intensive care unit admission
- Pregnancy
Studie plan
Hoe is de studie opgezet?
Ontwerpdetails
Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Intraoperative qCON and qNOX values during controlled hypotension
Tijdsspanne: From baseline before anesthesia induction until the end of surgery, up to approximately 150 minutes intraoperatively.
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qCON and qNOX values obtained by processed EEG monitoring will be recorded at predefined intraoperative time points.
qCON will be used as an index of hypnotic depth, and qNOX will be used as an index of the probability of response to nociceptive stimulation.
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From baseline before anesthesia induction until the end of surgery, up to approximately 150 minutes intraoperatively.
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Secundaire uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
|---|---|---|
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Heart rate during controlled hypotension
Tijdsspanne: From baseline before anesthesia induction until the end of surgery, up to approximately 150 minutes intraoperatively.
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Heart rate will be recorded at predefined intraoperative time points to evaluate hemodynamic stability.
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From baseline before anesthesia induction until the end of surgery, up to approximately 150 minutes intraoperatively.
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Andere uitkomstmaten
Uitkomstmaat |
Maatregel Beschrijving |
Tijdsspanne |
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Surgical field bleeding score
Tijdsspanne: Intraoperatively, from surgical incision until the end of surgery.
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Surgical field bleeding will be evaluated using the Boezaart surgical field bleeding score at predefined intraoperative time points.
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Intraoperatively, from surgical incision until the end of surgery.
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Extubation time
Tijdsspanne: At the end of surgery
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Time from discontinuation of anesthetic agents to extubation will be recorded in minutes
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At the end of surgery
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Time to reach Aldrete score ≥9
Tijdsspanne: Early postoperative recovery period, immediately after extubation.
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The time required to reach an Aldrete recovery score of 9 or higher will be recorded in minutes
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Early postoperative recovery period, immediately after extubation.
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Early postoperative delirium assessed by the Nursing Delirium Screening Scale
Tijdsspanne: At admission to the post-anesthesia care unit
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Patients were assessed for early postoperative delirium in the post-anesthesia care unit using the Nursing Delirium Screening Scale (Nu-DESC).
The Nu-DESC ranges from 0 to 10, with higher scores indicating more severe delirium symptoms.
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At admission to the post-anesthesia care unit
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Total anesthetic drug consumption
Tijdsspanne: From anesthesia induction until the end of surgery
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Total intraoperative consumption of propofol, remifentanil, and esmolol will be recorded
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From anesthesia induction until the end of surgery
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Medewerkers en onderzoekers
Sponsor
Onderzoekers
- Studie stoel: Nurdan Bedirli, MD, Gazi University
Publicaties en nuttige links
Algemene publicaties
- Laferriere-Langlois P, Morisson L, Jeffries S, Duclos C, Espitalier F, Richebe P. Depth of Anesthesia and Nociception Monitoring: Current State and Vision For 2050. Anesth Analg. 2024 Feb 1;138(2):295-307. doi: 10.1213/ANE.0000000000006860. Epub 2024 Jan 12.
- Aldecoa C, Bettelli G, Bilotta F, Sanders RD, Aceto P, Audisio R, Cherubini A, Cunningham C, Dabrowski W, Forookhi A, Gitti N, Immonen K, Kehlet H, Koch S, Kotfis K, Latronico N, MacLullich AMJ, Mevorach L, Mueller A, Neuner B, Piva S, Radtke F, Blaser AR, Renzi S, Romagnoli S, Schubert M, Slooter AJC, Tommasino C, Vasiljewa L, Weiss B, Yuerek F, Spies CD. Update of the European Society of Anaesthesiology and Intensive Care Medicine evidence-based and consensus-based guideline on postoperative delirium in adult patients. Eur J Anaesthesiol. 2024 Feb 1;41(2):81-108. doi: 10.1097/EJA.0000000000001876. Epub 2023 Aug 30.
- Kol IO, Kaygusuz K, Yildirim A, Dogan M, Gursoy S, Yucel E, Mimaroglu C. Controlled hypotension with desflurane combined with esmolol or dexmedetomidine during tympanoplasty in adults: A double-blind, randomized, controlled trial. Curr Ther Res Clin Exp. 2009 Jun;70(3):197-208. doi: 10.1016/j.curtheres.2009.06.001.
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Trefwoorden
Andere studie-ID-nummers
- 172
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