Hemorrhage Clinical Trial
Official title:
A Cohort Prospective Study of Predictors Influencing the Quality of Visualization of the Operating Field During Orthognathic Surgery
It is very important to decrease the bleeding during bimaxillary osteotomy in order to increase the visibility of the surgical site. Our primary goal is to investigate the predictive value of pre- and perioperative factors, including controlled hypotension, on visibility of surgical site during bimaxillary osteotomy.
Status | Enrolling by invitation |
Enrollment | 100 |
Est. completion date | June 15, 2026 |
Est. primary completion date | January 15, 2026 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 40 Years |
Eligibility | Inclusion Criteria: - Patients refered for bimaxillary osteotomy under general anesthesia with endotracheal intubation; - Anesthesia risk classes (ASA) I and II; - Written statement of informed consent. Exclusion Criteria: - Hypertension as a symptom of hypertensive heart disease or endocrine dysfunction; - Patients receiving antihypertensive drugs; - Patients receiving anticoagulant therapy; - Ischemic heart disease; - Cerebrovascular insufficiency; - Severe hypovolemia; - Anemia; - BMI 30 kg/m2 and higher; - Connective tissue disorders; - Pregnancy; - Participation in other clinical studies; - Recent history of substance abuse (recreational drugs, alcohol); - Allergies to drugs used in the study; - Anxiety requiring psychiatrist supervision and pharmacological therapy. |
Country | Name | City | State |
---|---|---|---|
Russian Federation | Pirogov National Medical and Surgical Center | Moscow |
Lead Sponsor | Collaborator |
---|---|
State Budgetary Healthcare Institution, National Medical Surgical Center N.A. N.I. Pirogov, Ministry of Health of Russia |
Russian Federation,
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* Note: There are 16 references in all — Click here to view all references
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Visibility of surgical site | Surgical site will be rated according to Modena Bleeding Score (MBS) by the same surgeon in terms of bleeding during osteotomy. The MBS goes from Grade 1 - no bleeding to Grade 5 - bleeding that prevents every surgical procedure except those dedicated to bleeding control. | during osteotomy, up to 90 minutes | |
Secondary | Proportion of patients with cerebral desaturation | Proportion of patients with decrease in cerebral oxygen saturation decreased by 20% compared with the baseline for 300 seconds without improvement | during osteotomy, up to 90 minutes | |
Secondary | changes in the values of mean arterial pressure | Changes in mean arterial pressure (MAP) values before and during controlled hypotension phase will be registered.
MAP calculated as follows: M?P = Diastolic blood pressure + ((Systolic blood pressure - Diastolic blood pressure) / 3). |
during the whole surgery (from start to finish - the timing stated in the surgery protocol) | |
Secondary | Changes in neuron-specific enolase (NSE) concentration | NSE is released from neurons during injury and it's high blood concentration is associated with ischemic brain injury. Level of NSE will be measured in blood samples taken during surgery. Increase of NSE level suggests brain ischemia. | 3 time-points during the surgery - immediately after anesthesia induction, at the time of controlled hypotension (5 minutes after induction of controlled hypotension, i.e. nitroglycerin i.v. administration), immediately after extubation | |
Secondary | Intraoperative blood loss | Total volume of blood loss during the time of surgery, calculated using direct volumetric measurement. | during the whole surgery (from start to finish - the timing stated in the surgery protocol) | |
Secondary | Cognitive status change | Cognitive function will be evaluated by means of Mini Mental State Examination (MMSE), which is a 30-point test, validated and commonly used to measure cognitive impairment. Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (=9 points), moderate (10-18 points) or mild (19-23 points) cognitive impairment. | within 3 days before operation, 2 days after surgery, 1 month after surgery | |
Secondary | Changes in cystatin C concentration | Cystatin C is a well investigated biomarker with clear advantages over serum creatinine in patients with extremes in muscle mass, weight, age, and other areas where estimating equations using creatinine have well documented limitations. Increase of cystatin C level suggests kidney impairment. | at the start of the surgery, during controlled hypotension phase, immediately after extubation | |
Secondary | Change in Troponin I concentration | The test can be used to aid in diagnosing myocardial infarction. | at the start of the surgery, during controlled hypotension phase, immediately after extubation |
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