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Difference in BS was reported for 5-RTP vs 20-RTP (0.6), 10-RTP vs 20-RTP (0.4), and 5-RTP vs 10-RTP (0.2). The difference in BS was statistically significant between the 5-RTP and 20-RTP groups (p CHIR-99021 ic50 95% CI, 0.3 to 0.9). A significant difference was not found between 10-RTP vs 20-RTP and 5-RTP vs 10-RTP (p = 0.03; 95% CI, 0.03�C0.8; and p = 0.3; 95% CI, ?0.1 to 0.6, respectively). Differences in mean BL were recorded for 5-RTP vs 20-RTP (95.8 mL), 10-RTP vs 20-RTP (94.6 mL), and 5-RTP vs 10-RTP (1.2 mL). Pairwise comparisons of differences in mean BL did not significantly differ (p = 0.05, 0.05, and 0.99, respectively). The incidence of nasal septal reconstruction was unequally distributed among study groups (5-RTP and 10-RTP: 68%, 20-RTP: 36%). We found that the regression estimates and standard error between the primary outcomes and head position, with or without adjustment for septal reconstruction, were comparable. The changes in BS and TBL were similar between unadjusted and adjusted models (Table?4). The reference group for the multivariate linear regression model was patients oriented 5-RTP without nasal septal reconstruction performed. The incidence of nasal polyposis in our series was too small (10.7%) to allow statistical Fleroxacin analysis of its impact on BS, TBL, and operating time. RTP is a head-up and feet-down tilt varying from 10 to 30 degrees.[15] This position has been used for many years by neurosurgeons to reduce intracranial pressure during craniotomy.[16] Recently, RTP has also been shown to be effective in reducing bleeding in FESS.[10, 17] The proposed mechanism is a decrease in venous return from the effect of gravity, resulting in a lower cardiac output. The mean arterial pressure (MAP), however, is maintained due to compensatory measures by the blood pressure regulatory mechanism in the aortic arch and carotid Y-27632 in vivo sinuses. Therefore, it is postulated that the decrease in venous return, and not in MAP, reduces blood loss during FESS in RTP.[17] Other benefits of RTP during anesthesia include improved oxygenation in obese patients and reduced postoperative nausea and vomiting.[11, 12] In obese patients undergoing bariatric surgery, tilting the patient's head up will counteract the abdominal push on the diaphragm. This, in turn leads to an increase in lung functional residual capacity (FRC) and improved oxygenation.[11] Reduction in postoperative nausea and vomiting in the head-up position is believed to be a result of a decrease in craniocervical venous congestion.[12] In 2008, Ko et al.[17] was the first to study the effects of RTP during FESS. Their RCT involved 30 patients placed in the HP and 30 patients in 10-RTP during FESS. Their study showed that FESS in 10-RTP resulted in significantly less intraoperative TBL and BL/min, and improved surgical field compared to that in the supine position.