Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial

Abstract

BackgroundThe beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO2) in the BCP.MethodsPatients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO2 were recorded.ResultsData were analyzed from 19 patients per group. In the BCP, the values of rSO2 and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO2 and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO2 and blood pressure.ConclusionsThigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.

Effect of phenylephrine infusion on hypotension induced by the beach chair position

“…Thus, it is important to increase cardiac preload and the TSVRi. Application of a sequential compression device [ 12 ] or stocking [ 3 ] can reduce venous pooling in the lower extremities, and reduce hemodynamic derangements after a positional change.…”

“…There are many challenges in preventing intraoperative hypotension during the BCP. Application of compression stocking [ 3 ] and vasopressor infusion [ 4 , 5 ] can be helpful to prevent hypotension during the BCP. Arginine vasopressin, a strong vasoconstrictor, is effective in preventing hypotension during the BCP, but it causes a significant decrease of brain oxygenation.…”

Watch beyond hypotension

“…In this month’s the Korean Journal of Anesthesiology , an interesting paper focusing on the beach chair position (BCP) was published. Woo et al [ 1 ] report that efforts to manage hypotension may not contribute to reducing cerebral desaturation events (CDEs) in the BCP under general anesthesia.…”

“…Woo et al [ 1 ] showed that the increase in venous return produced by compression stockings could correct hypotension but did not decrease CDEs. This indicates that blood pressure measurements alone might not be useful in predicting the occurrence of CDEs, and that other factors beyond blood pressure contribute to CDEs in the BCP.…”

“…I hope that the recent study of Woo et al [ 1 ] will serve as an impetus to raise awareness of the importance of cerebral oxygenation monitoring and to change the relevant NHI regulation.…”