Risk Factors for Cerebral Desaturation Events During Shoulder Surgery in the Beach Chair Position

Frozen Shoulder 360° Release

“…In addition, it is believed that the lateral position poses less risk of cerebral hypoperfusion, and hence the development of neurologic injury, compared with the beach chair position. 10 Apart from the risk of axillary nerve injury, there is a possible risk of destabilizing the shoulder after a circumferential release of the capsule. This complication has not been widely reported in the literature except for 1 case of frank dislocation and another case of mild subjective symptom of instability.…”

Editorial Commentary: “A Rush of Blood From the Head”—Predicting and Preventing Cerebral Deoxygenation During Beach-Chair Shoulder Surgery

“…Our research has shown that CDEs appear to be limited to those patients undergoing general anesthesia; patients who receive regional anesthesia and sedation while in the beach-chair position have not shown CDEs in our studies 10 or in the current article. 7 Other risk factors are relative hypotension, for which patients under general anesthesia are often poorly able to compensate. The article by Gilotra et al 7 with the remainder having undergone open procedures such as arthroplasty.…”

“…7 Other risk factors are relative hypotension, for which patients under general anesthesia are often poorly able to compensate. The article by Gilotra et al 7 with the remainder having undergone open procedures such as arthroplasty. Cerebral oxygenation was measured using nearinfrared spectroscopy.…”

“…In their article, Gilotra et al 7 also describe a meticulous protocol designed to minimize cerebral deoxygenation. This consisted of risk stratification, normotensive anesthesia, and most interesting, patient positioning in a staged fashion, with initial head elevation to 35 , followed by a wait of 3 minutes, and then further elevation to 70 .…”

“…14 The head should be gradually elevated and as minimally as possible. 17 Although progress remains to be made to eliminate the rate of CDEs in patients under general anesthesia, we thank Gilotra et al 7 for continuing to bring this critical issue to light and for promoting methods to reduce the risk of devastating ischemic injury for shoulder patients.…”