Comparing the Reverse Trendelenburg and Horizontal Position for Endoscopic Sinus Surgery
Bibliographic record
Abstract
OBJECTIVE: To determine whether the 15-degree reverse Trendelenburg position (RTP) during functional endoscopic sinus surgery improves endoscopic field of view and reduces intraoperative blood loss when compared with the horizontal position (HP). STUDY DESIGN: A prospective, randomized controlled trial. SETTING: St Paul's Sinus Centre, Vancouver, Canada. SUBJECTS: Patients with chronic rhinosinusitis (CRS), with or without nasal polyposis, receiving functional endoscopic sinus surgery were included. Patients were excluded if they had severe or uncontrolled hypertension and cardiovascular disease, continued use of anticoagulants, impaired coagulation, or a sinonasal tumor. METHODS: Sixty-four patients with CRS undergoing functional endoscopic sinus surgery (FESS) were randomized to either 15-degree RTP (experimental arm) or HP (control arm) from October 2011 to February 2012. Boezaart endoscopic field-of-view grading system was the primary outcome measure. Lund-Mackay computed tomography (CT) score, total blood loss, blood loss per minute, mean arterial pressure, heart rate, anesthetic technique, and surgery time were also recorded. RESULTS: There was a significant difference in mean Boezaart scoring between RTP and HP: 1.66 vs 2.33 (P < .001), with RTP producing a better endoscopic field of view. There was also a lower total blood loss and blood loss per minute with RTP (P = .01, P = .03). There was no significant difference in disease severity (P > .05), time of surgery (P > .05), or mean arterial pressure (P > .05) between the 2 surgical positions. CONCLUSION: The 15-degree RTP improves the endoscopic field of view and reduces blood loss during FESS. We would therefore recommend its use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".