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

Luedi, Markus M.; Bendjelid, Karim

doi:10.1007/s10877-016-9950-5

Cited by 3 publications

(3 citation statements)

References 16 publications

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“…Yet, no guideline specifically states the minimal monitoring to be used in patients with PNB and some of the authors are aware of centers performing regional anesthesia without standard monitoring. Although our data can certainly not be considered as providing evidence, the fact that standard monitoring was regularly used by most anesthesiologists in Switzerland may serve as a “benchmark” for discussions when defining upcoming guidelines 5 .…”

Section: Discussionmentioning

confidence: 95%

“…Although our cohort was limited to members of SSAR/SGAR and the qualitative survey may primarily reflect specific practice in Switzerland descriptively, our data shed light on anesthetists’ current clinical practices and technical approaches to localizing peripheral nerves for regional anesthesia. While our descriptive study does not necessarily reveal new ideas or practices, it presents insights into nationwide professional behavior and, thus, can support clinical judgment in other countries and practice environments 5 . Further, due to its methodological nature, the preliminary, exploratory design of the qualitative survey without formal control might limit the reliability and validity of the survey data in other settings, but the results are an important step towards the definition of recommendations and guidelines for best clinical practice.…”

Section: Discussionmentioning

confidence: 98%

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A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks

Luedi

Upadek

Vogt

et al. 2019

Sci Rep

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Ultrasound has significantly increased safety and effectiveness in regional anesthesia. However, little is known about its clinical use. We studied clinical approaches currently used by anesthesiologists, conducted a nationwide survey, and analyzed data collected in ordered logistic regression models. All active members of the Swiss Society for Anaesthesiology and Resuscitation (SSAR/SGAR) were asked to participate. Reported practice in nerve localization, safety, and techniques used for peripheral nerve blocks (PNB) were main outcome measures. Experience ranged from 3 to >30 years. The mean number of block techniques mastered was 11.5 ± 5.9. Standard monitoring was regularly used, whereas sterile coats were less frequently used by anesthesiologists who self-estimated a higher level of expertise in PNB (ordered logit coefficient −0.05, 95% CI −0.07 to −0.02, P < 0.001 ; pseudo r2 = 0.019; probability > Chi2 = 0.02). The more self-estimated expertise anesthesiologists had, the less likely they were to use nerve stimulation in combination with ultrasound (dual guidance) (ordered logit coefficient −0.31; 95% CI −0.85 to −0.03: P = 0.03; pseudo r2 = 0.007; probability > Chi2 = 0.05). The high share of reported standard monitoring meets the recommendations of the Helsinki Patient Safety Declaration. Dual guidance appears to be the preferred approach for safely localizing nerves for PNB in Switzerland.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks

Luedi

Upadek

Vogt

et al. 2019

Sci Rep

Self Cite

View full text Add to dashboard Cite

show abstract

“…In these cases, special attention should be given to manage ABP within normal ranges with vasopressors or fluids before and throughout beach chair position. In this context, recent studies have even suggested the use of invasive arterial lines to improve the monitoring of ABP and consequently cerebral blood flow in the BCP operative setting [46, 47]. Moreover, the technique of calibrating invasive arterial blood pressure at the auditory meatus level could potentially prevent low cerebral perfusion pressure in patients positioned with an elevated head.…”

Section: Discussionmentioning

confidence: 99%

Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach

Cardim

Robba

Matta

et al. 2018

J Clin Monit Comput

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Although the beach-chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of brain ischaemia. We assessed cerebral haemodynamics using a multiparameter transcranial Doppler-derived approach in patients undergoing shoulder surgery. 23 anaesthetised patients (propofol (2 mg/kg)) without history of neurologic pathology undergoing elective shoulder surgery were included. Arterial blood pressure (ABP, monitored with a finger-cuff plethysmograph calibrated at the auditory meatus level) and cerebral blood flow velocity (FV, monitored in the middle cerebral artery) were recorded in supine and in BCP. All subjects underwent interscalene block ipsilateral to the side of FV measurement. We evaluated non-invasive intracranial pressure (nICP) and cerebral perfusion pressure (nCPP) calculated with a black-box mathematical model; critical closing pressure (CrCP); diastolic closing margin (DCM—pressure reserve available to avoid diastolic flow cessation); cerebral autoregulation index (Mxa); pulsatility index (PI). Significant changes occured for DCM [mean decrease of 6.43 mm Hg (p = 0.01)] and PI [mean increase of 0.11 (p = 0.05)]. ABP, FV, nICP, nCPP and CrCP showed a decreasing trend. Cerebral autoregulation was dysfunctional (Mxa > 0.3) and PI deviated from normal ranges (PI > 0.8) in both phases. ABP and nCPP values were low (< 60 mm Hg) in both phases. Changes between phases did not result in CrCP reaching diastolic ABP, therefore DCM did not reach critical values (≤ 0 mm Hg). BCP resulted in significant cerebral haemodynamic changes. If left untreated, reduction in cerebral blood flow may result in brain ischaemia and post-operative neurologic deficit.

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Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and hemodynamic monitoring

Saugel

Bendjelid

Critchley

et al. 2018

J Clin Monit Comput

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Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.

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

Cited by 3 publications

References 16 publications

A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks

A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks

Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach

Journal of Clinical Monitoring and Computing 2017 end of year summary: cardiovascular and hemodynamic monitoring

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