Mode of Ventilation and Bleeding During Transsphenoidal Surgery

Not Applicable

Completed

Interventions: Procedure: Pressure-controlled ventilation
Procedure: Volume controlled ventilation

Brief Summary: The risk of bleeding is important during transsphenoidal surgery. This study aims to find if the ventilation mode, controlled pressure and controlled volume, modifies the risk of bleeding.

Detailed Description: The risk of bleeding is important during transsphenoidal surgery. This study aims to find if the ventilation mode, controlled pressure and controlled volume, modifies the risk of bleeding.

* group Volume controlled ventilation: tidal volume of 7 mL/kg ideal body weight, frequency of 12 cycles/minute, I/E ratio of 1:2, no positive end expiratory pressure. Ventilatory frequency is changed if necessary to maintain end-expiratory pressure of CO2 between 35 and 40 mmHg.

* group Pressure-controlled ventilation: initial pressure of 15 cm H2O, frequency of 12 cycles/minute, I/E ratio of 1:2, no positive end expiratory pressure. Pressure is modified to maintain a tidal volume of 7 mL/kg of ideal body weight and frequency ventilation is modified to maintain end-expiratory pressure of CO2 between 35 and 40 mmHg.

* In both groups, the fraction of inspired oxygen is 50%. A recruitment maneuver is performed if the blood oxygen saturation became less than 92%.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Pregnancy
Obesity (BMI> 35)
Known respiratory disease
Redo surgery
Preoperative problem with hemostasis (antiplatelet or anticoagulant treatment; constitutional disorder).

Arm && Interventions

Group	Intervention	Description
Pressure-controlled ventilation	Pressure-controlled ventilation	initial pressure of 15 cm H2O, frequency of 12 cycles/minute, I/E ratio of 1:2, no positive end expiratory pressure. Pressure is modified to maintain a tidal volume of 7 mL/kg of ideal body weight and frequency ventilation is modified to maintain end-expiratory pressure of CO2 between 35 and 40 mmHg
Volume controlled ventilation	Volume controlled ventilation	Volume controlled ventilation: tidal volume of 7 mL/kg ideal body weight, frequency of 12 cycles/minute, I/E ratio of 1:2, no positive end expiratory pressure. Ventilatory frequency is changed if necessary to maintain end-expiratory pressure of CO2 between 35 and 40 mmHg.

Primary Outcome Measures

Name	Time	Method
intraoperative bleeding	1 hour postoperatively	intraoperative bleeding is estimated by the operator (always the same) as minimal (1), low (3), with no significant change in the conduct of the surgical procedure (5) with significant change in the conduct of surgical procedure (7). Intermediate levels are used to rate the levels of intermediate severity.

Secondary Outcome Measures

Name	Time	Method
recruitment maneuver	one hour after surgery	number of recruitment maneuver
generated plateau pressures	one hour after surgery	mean ventilatory plateau pressure during surgery
changes of ventilation mode	one hour after surgery	number of changes of ventilation mode
arterial desaturation	one hour after surgery	number of episodes of arterial desaturation (SpO2 \<92%) and lower arterial saturation during surgery
realisation of predefined objectives of minute ventilation	one hour after surgery	time spent with the predefined objectives of minute ventilation
duration of the surgical procedure	one hour after surgery	duration from surgical incision to end of the surgical procedure
endocrine healing	three months after surgery	return to a low level of the abnormal endocrin abnormalities

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