Induced Hypotension, Nasal Septum Deviation, Rhinoplasty
Conditions
Brief summary
This prospective observational study aims to evaluate the neurological safety of controlled hypotension (Mean Arterial Pressure 50-65 mmHg) during elective rhinoplasty. The investigators will assess whether this standard intraoperative hypotensive strategy causes cellular stress by measuring serum Glial Fibrillary Acidic Protein (GFAP) levels and early postoperative cognitive changes using the Montreal Cognitive Assessment (MoCA) test.
Detailed description
Controlled hypotension is frequently utilized in rhinoplasty to minimize bleeding and improve the surgical field. However, the potential cellular stress on the brain due to reduced cerebral perfusion is not fully understood. This study will enroll 40 ASA I-II patients undergoing elective rhinoplasty under general anesthesia with sevoflurane. Blood samples will be drawn at baseline (after anesthesia induction) and 24 hours postoperatively to measure serum GFAP levels via ELISA. Cognitive functions will be evaluated simultaneously using the MoCA test. The primary objective is to determine the change in GFAP concentrations, and the secondary objective is to evaluate its correlation with early postoperative cognitive scores.
Interventions
PROCEDUREControlled Hypotension (Standard of Care)
Maintenance of Mean Arterial Pressure (MAP) between 50 and 65 mmHg during the surgical procedure to optimize the surgical field.
Sponsors
Kahramanmaras Sutcu Imam University
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
* Scheduled for elective rhinoplasty or septorhinoplasty under general anesthesia. * ASA physical status I or II. * Literate and willing to provide written informed consent.
Exclusion criteria
* History of neurological (e.g., cerebrovascular event, epilepsy) or psychiatric diseases. * Total septal reconstruction requiring costal (rib) cartilage grafts. * Expected surgical duration exceeding 3 hours. * Preoperative severe cognitive impairment. * Pregnancy or lactation.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Serum Glial Fibrillary Acidic Protein (GFAP) Level | Baseline (T0: Post-induction) and 24 hours postoperatively (T1). | GFAP is a biomarker of astrocyte stress and blood-brain barrier permeability. Measured via ELISA (pg/mL). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Montreal Cognitive Assessment (MoCA) Score | Baseline (Preoperative ward visit) and 24 hours postoperatively. | The MoCA is a 30-point screening tool for detecting cognitive dysfunction. Higher scores indicate better cognitive function (Range: 0-30). |
| Duration of Target Hypotension | Intraoperative period (from surgical incision to end of surgery, approximately 1-3 hours). | Total time (in minutes) the patient's Mean Arterial Pressure (MAP) is maintained within the target range of 50-65 mmHg. |
Contacts
CONTACTCengizhan Yavuz
Outcome results
None listed