Foreseeing the danger in the beach chair position: Are standard measurement methods reliable?

Abstract

Cerebral oximetry by NIRS may prove useful as a monitor for cerebral ischaemia. In the absence of NIRS, CHR can partially detect abnormalities but not trustable, and MAP is the most reliable method for monitoring.

Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

“…Our meta-analysis of HR-responses over time considered two sub-groups based on the type of anaesthesia and maintenance agents used. BL-HR was reported in 48 SGs ( n = 1334); 12 used TIVA-propofol[ 16 33 34 35 36 37 ] (73.7 ± 13.4 beats/min, n = 451), 33 received inhaled anaesthetics[ 16 29 35 38 39 40 41 42 43 44 45 46 47 48 49 50 ] (73.6 ± 13.6 beats/min, n = 744) and 139 subjects had ISB. [ 6 50 ] MDs between HR-values at supine (Pre-BCP) and post-BCP status are depicted in Figure 4 .…”

“…Sensitivity analysis revealed that various anaesthetic agents significantly influenced fall in HRs. However, it made little difference to the overall results when study controls[ 29 30 33 34 35 37 39 40 41 42 43 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] and randomised trials[ 4 6 12 13 15 16 26 27 28 29 30 33 34 35 37 38 39 41 42 44 45 46 47 50 55 60 61 64 ] were analysed separately [ Table 2 ]. Meta-regression was performed since primary outcomes, characterised by significant heterogeneity, yielded statistically significant omnibus P values for statistical models considering different maintenance agents and opioids.…”

Cerebral oximetry

“…Case reports of dramatic adverse neurological outcomes in relatively healthy patients after shoulder surgery in the beach chair position (BCP) have pointed out the limitations of current routine anesthesia monitoring [13]. Although the incidence of severe adverse neurologic outcomes seems to be low, it is likely to be underreported [14].…”

Hemodynamic monitoring during surgeries in beach chair position: What can a big picture teach us?

“…Salazar et al reported a 18% incidence of cerebral desaturation events in patients during shoulder surgery in beach chair position [14]. Regional cerebral tissue oxygen saturation (SrcO 2 ) may help to detect cerebral ischemia during procedures in beach chair position [15]. Which device to monitor SrcO 2 in specific clinical contexts such as surgeries in beach chair position remains to be evaluated [16].…”

“…Which device to monitor SrcO 2 in specific clinical contexts such as surgeries in beach chair position remains to be evaluated [16]. However, if such devices are not available, MAP remains a reliable measure for monitoring [15].…”