Improving the safety of shoulder arthroscopy in the beach chair position: a prospective randomized trial investigating the effect of compression stockings on cerebral desaturation events in obese patients

Golz, Andrew; Davis, William J.; Perry, Michael; Tonino, Pietro; Garbis, Nicholas; Salazar, Dane

doi:10.1016/j.jse.2020.05.037

Cited by 4 publications

(11 citation statements)

References 46 publications

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“…Cerebral oxygenation monitoring was performed using INVOS™ 5100 B/C (Medtronic, Ireland) cerebral oximetry monitoring devices [ 7 , 13 , 20 - 27 , 29 ] (near-infrared reflectance spectroscopy) in all included studies in this review, except in a single study [ 28 ] in which the FORE-SIGHT™ device (Edwards Lifesciences, USA) was used. All the studies reported baseline data with respect to rSO 2 including pre- and post-induction values, except for a single study [ 24 ] in which only the mean (SD) maximum fall of cerebral saturation values was reported. The physiologic principles to prevent CDEs followed in each included study, however, were dissimilar.…”

Section: Resultsmentioning

confidence: 99%

“…To simplify, we classified the included heterogeneous studies based on whether the study authors used pharmacological (PPMs) or non-pharmacological prophylactic measures (NPPMs). For the prevention of MAP-dependent cerebral desaturations, PPMs were used in four RCTs (vasoactive agents; vasopressin [ 20 , 21 , 25 ], n = 3 and phenylephrine [ 7 ], n = 1) and NPPMs in eight (preloading with colloid [HES 130/0.4 [ 22 ], n = 1]; SCD use on legs [ 26 ], n = 1; compression stockings [ 13 , 24 ], n = 2; targeted mild hypercarbia [ 27 , 28 ], n = 2; or reduced BCP angle for surgery [ 23 ] [low BCP angle, ≤ 60º, n = 1] or RIPC [ 29 ], n = 1]). However, overlapping prophylactic measures were observed among the study groups.…”

Section: Resultsmentioning

confidence: 99%

“…However, overlapping prophylactic measures were observed among the study groups. Eight study groups [ 13 , 20 , 21 , 24 ] used compression stockings and five used SCDs [ 23 , 24 , 26 ] as a prophylactic measure. Crystalloid loading [ 7 , 21 , 22 , 29 ] and HES preloading [ 22 , 26 , 27 ] were used in 10 and 5 study groups, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Vasoactive agent prophylaxis [ 7 , 20 , 21 , 25 ] was used in seven, whereas targeted mild hypercarbia [ 27 , 28 ] was used in two study groups. Similarly, low BCP angle [ 13 , 23 , 24 ] during surgery was used in five study groups. However, the RIPC technique was used in only a single study [ 29 ] group.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-regression analysis included 11 studies [ 7 , 13 , 20 – 23 , 25 – 29 ]. One study [ 24 ] did not report baseline values; therefore, the study was not considered for meta-regression analysis. Meta-regressions revealed a statistically significant highest estimate (estimate: 7.8, SE: 1.534, 95% CI [4.8, 10.8], P < 0.001) for vasoactive agent prophylaxis use (PPMs, higher positive coefficients represent a greater fall of rSO 2 in BCP compared to supine) compared to NPPMs ( Table 1A ).…”

Section: Resultsmentioning

confidence: 99%

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Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis

Tantry

Muralishankar

Karanth

et al. 2021

Korean J Anesthesiol

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Background: Prophylaxis for cerebral desaturation events (CDEs) during anesthesia in the beach chair position (BCP) for shoulder surgeries has not been evaluated. We systematically analyzed the effectiveness of various prophylactic measures used in this clinical setting.Methods: We performed a meta-analysis (PROSPERO; no. CRD42020167285) of trials reporting CDEs and regional cerebral oxygen saturation (rSO2) and jugular venous oxygen saturation (SjvO2) values in anesthetized patients undergoing shoulder surgery in BCP. Considering the type of prophylactic measures used (pharmacological or non-pharmacological), a subgroup analysis was planned. Outcomes included (1) rSO2 and SjvO2 data with and without prophylactic measures for CDEs, recorded for different time intervals, and (2) the number of patients experiencing CDEs and hypotension. Results: Twelve studies (786 patients) were included in the analysis. We observed lower absolute rSO2 values for early and all-time periods for vasoactive agent prophylaxis. The lowest achieved rSO2 values were also lower for vasoactive agent prophylaxis. Risk of CDEs was higher with vasoactive agent prophylaxis. Subgroup analysis identified targeted mild hypercarbia as effective in preserving cerebral oxygenation. Similarly, targeted mild hypercarbia prevented the fall in rSO2 with position change. Meta-regressions revealed statistically significant highest estimates for vasoactive agent prophylaxis in contrast to targeted mild hypercarbia. Likelihood of not developing CDEs was higher for targeted mild hypercarbia. In contrast to rSO2, most prophylactic methods reduced hypotensive episodes. Conclusions: Targeted mild hypercarbia can reduce BCP-related CDEs. Evidence does not favor prophylactic use of vasoactive agents for the prevention of cerebral desaturations irrespective of whether their use interferes with cerebral oximetry readings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis

Tantry

Muralishankar

Karanth

et al. 2021

Korean J Anesthesiol

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Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly

Groene,

Schaller,

Zeuzem-Lampert

et al. 2023

Arch Orthop Trauma Surg

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Ultrasound-guided interscalene block anesthesia performed by an orthopedic surgeon: a study of 1322 cases of shoulder surgery

2022

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Background Interscalene blocks are becoming increasingly common for shoulder surgeries. This study primarily aimed to demonstrate the efficacy and complications and the secondarily to investigate the anesthesia-related time and patient satisfaction of an ultrasound-guided interscalene block performed by an orthopedic surgeon. Methods We retrospectively reviewed the medical records of 1322 consecutive patients (arthroscopic, 1225 cases; open, 97 cases) with a mean age of 64.2 years, who underwent shoulder surgery (arthroscopic or opensurgery) under an ultrasound-guided interscalene block performed by an orthopedic surgeon at a single institution between December 2012 and December 2019. We investigated patient satisfaction, block success rates, and complications and also compared the anesthesia-related time of an interscalene block with that of general anesthesia (428 cases, arthroscopic, 257 cases; open, 171 cases) for shoulder surgery with patients in the beach chair position during the same period. Difference between total anesthesia time and surgical time was defined as anesthesia-related time. Results Approximately 98.3% of patients were satisfied with an interscalene block, and the block success rate on the first attempt was 99.9%. Total complication incidence was 2.3%, with no recorded life-threatening complications. Anesthesia-related times were significantly shorter in the interscalene block group than those in the general anesthesia group (45 ± 14 min vs. 100 ± 26 min, P < .001). Conclusion An ultrasound-guided interscalene block performed by an orthopedic surgeon for shoulder surgery is effective and safe, requires less time, and has a high patient acceptance rate, making it a feasible and alternative to the block performed by anesthesiologists.

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Improving the safety of shoulder arthroscopy in the beach chair position: a prospective randomized trial investigating the effect of compression stockings on cerebral desaturation events in obese patients

Cited by 4 publications

References 46 publications

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis

Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries: a systematic review and meta-analysis

Postoperative cognitive dysfunction after beach chair positioning compared to supine position in orthopaedic surgery in the elderly

Ultrasound-guided interscalene block anesthesia performed by an orthopedic surgeon: a study of 1322 cases of shoulder surgery

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