The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension: Impact on cerebral oxygenation, cerebral blood flow and neurobehavioral outcome

Aguirre, José; Etzensperger, Fabian; Brada, Muriel; Guzzella, Sandra; Saporito, Andrea; Blumenthal, Stephan; Bühler, Philipp; Borgeat, Alain

doi:10.1016/j.jclinane.2018.09.035

Cited by 34 publications

(39 citation statements)

References 37 publications

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“…The use of cerebral oximetry using near-infrared spectroscopy (NIRS) to monitor the adequacy of cerebral perfusion and to guide intraoperative interventions in shoulder surgery has become more common over the last decade. 1,3,4,91011121314151617181920212223242526272829303132…”

Section: Proposed Pathoanatomymentioning

confidence: 99%

“…Aguirre et al 10 performed a study to assess the effect of general anesthesia and controlled hypotension on cerebral saturation (rScO 2 ), cerebral blood flow, and neurobehavioral outcomes in 40 patients undergoing shoulder surgery in BCP. They collected neurologic and neurobehavioral tests including the Trail Making Tests A and B and the Grooved Pegboard test.…”

Section: Correlation Between Intraoperative Cerebral Perfusion Deficimentioning

confidence: 99%

“…There were no neurologic deficits, but patients with CDEs performed worse on the Trail Making Test B and the Grooved Pegboard test 24 hours after surgery compared with patients without CDEs ( P = 0.001). 10…”

Section: Correlation Between Intraoperative Cerebral Perfusion Deficimentioning

confidence: 99%

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Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

et al. 2019

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The beach chair position (BCP) is commonly used position in upper extremity surgery. Although there are many advantages to surgery in this position, there are also potential drawbacks and described complications including devastating neurologic outcomes. The etiology of these complications is postulated to be due to the gravitational effects of the seated position leading to cerebral hypoperfusion. We review the current literature on intraoperative cerebral monitoring and neurocognitive complications with shoulder surgery performed in the BCP. A previous systematic review estimated the incidence of neurocognitive complications after surgery in the BCP to be 0.004%. However, the true incidence is unknown and is likely much more common. Reports of neurologic complications have revealed a need for heightened vigilance, alternative anesthesia techniques, and improved monitoring. Methods for monitoring have included near-infrared spectroscopy, a measurement of cerebral oximetry shown to reliably detect cerebral hypoperfusion. In this literature review, we sought to update the incidence of intraoperative cerebral desaturation events (CDEs) to investigate the relationship of CDEs to neurocognitive complications and to review recent reported cases of neurocognitive complications. Existing literature suggest that accurate intraoperative monitoring of cerebral perfusion may improve patient safety.

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Section: Proposed Pathoanatomymentioning

confidence: 99%

Section: Correlation Between Intraoperative Cerebral Perfusion Deficimentioning

confidence: 99%

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Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

et al. 2019

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“…Intravenous general anesthesia and controlled hypotension in the beach chair position (65°) were found to affect cerebral blood flow and cerebral oxygenation; the incidence of cerebral desaturation events was 25% and there were no neurological deficits. [38] In another study, pre-operative interscalene brachial plexus (BP) block and advanced age were risk factors associated with symptomatic hypotensive bradycardic events in the beach chair position. [39] The beach chair position angle was shown to affect cerebral oxygenation, and there was a linear decline in cerebral oxygenation as the position angle increased.…”

Section: Anesthesia and Positioning In Shoulder Arthroscopymentioning

confidence: 99%

Recent advances and future trends in shoulder arthroscopy

DeNiese¹,

Bhatia²

2020

JASSM

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Shoulder arthroscopy has evolved significantly over the past decade. Treatment algorithms have evolved in sync with results from cadaveric, biomechanical, and clinical studies, and newer minimally invasive and biomechanically proven surgical techniques have replaced suboptimal procedures. Advances in arthroscopy have influenced three key aspects of shoulder problems: Anterior instability, rotator cuff tears, and osteoarthritis. A new frontier of “endoscopic” extra-articular procedures has evolved and these procedures have convincingly replaced traditional open surgeries. The current evidence suggests a growing trend for arthroscopic procedures in joint preservation and restoration.

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“…Cerebral perfusion pressure decreases by approximately 15% in the sitting position in non-anesthetized patients and further decreases under anesthesia because of vasodilation and impaired venous return. Hypotensive bradycardic events (HBEs), a form of vasovagal reflex unique to the beach chair position, can potentially increase the risk of neurocognitive complications [5]. In South Korea, neurological injuries related to the beach-chair position for shoulder surgery were identified as typical injury profiles in the recent Korean Society of Anesthesiologists Legislation Committee report [4].…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with hypotensive bradycardic events during open shoulder surgery in the beach chair position

Choi

Kim

Jeong

et al. 2021

Korean J Anesthesiol

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Background: Shoulder surgery in the beach chair position frequently causes hypotensive bradycardic events (HBEs), which are potentially associated with an increased risk of cerebral hypoperfusion. Here, we aimed to investigate the incidence and characteristics of symptomatic HBEs that require pharmacological interventions, and to identify specific risk factors associated with symptomatic HBEs. Methods: We retrospectively examined the records of all patients aged ≥ 18 years who underwent shoulder arthrotomy in the beach chair position between January 2011 and December 2018 at a tertiary hospital. For patients who experienced HBEs while in the beach chair position, the minimum heart rate and systolic blood pressure were noted, as was the total dose of ephedrine or atropine. Results: Symptomatic HBEs occurred in 61.0% of all cases (256/420). Two patients with symptomatic HBEs experienced postoperative neurological complications. Multivariable logistic regression analysis showed that preoperative interscalene brachial plexus block (ISB) and advanced age were risk factors associated with symptomatic HBEs

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The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension: Impact on cerebral oxygenation, cerebral blood flow and neurobehavioral outcome

Cited by 34 publications

References 37 publications

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Recent advances and future trends in shoulder arthroscopy

Risk factors associated with hypotensive bradycardic events during open shoulder surgery in the beach chair position

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