Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position

Abstract

BackgroundCerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO2) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart).MethodsFifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO2, bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision.ResultsA correlation between the cerebral rSO2 and the MAP at the level of brain were statistically significant. Cerebral rSO2 and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value.ConclusionsMonitoring cerebral rSO2 and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

“…In our patient series, the incidence of CDE was 18% (nine of 51). Because cerebral oximetry values are affected by depth of anesthesia, type of anesthetic administered, arterial carbon dioxide concentration, inspired oxygen content, mean arterial blood pressure, and operative position, there is no consensus in the literature defining the optimal time point at which to measure a patient's baseline [14,16,22,23]. The goal of our protocol was to establish a reference point that most accurately represented the physiologic cerebral saturation baseline unique to each subject.…”

“…This US Food and Drug Administration-approved technology is extensively used in patient populations undergoing procedures at high risk for adverse neurologic outcomes such as cardiac, vascular, transplant, and major abdominal surgery [3,20,33]. Multiple small case series and case reports have documented intraoperative cerebral desaturation episodes and rare catastrophic neurocognitive complications from shoulder surgery in the semiupright position [1,5,7,9,16,22,23,26,34].…”

Effects of Positioning on Cerebral Oxygenation

“…A number of studies, including case reports, observational studies and a randomized trial have used ScO 2 measurement to monitor cerebral oxygenation during beachchair surgery (Table 1) [29,125,[128][129][130][131][132][133][134][135]. These studies confirm that beachchair positioning is associated with hypotension and ScO 2 desaturation, ranging from 0 % to over 80 %.…”

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

“…Not surprisingly, several groups have reported their experience on the use of cerebral oximetry during shoulder surgery in the BCP, and every group revealed significant decreases in SctO 2 during the procedure. [6][7][8][9][10][11][12][13] Nevertheless, many questions remain about what constitutes a ''normal'' SctO 2 value and what SctO 2 values are acceptable during general anesthesia.…”