Under General Anesthesia Arginine Vasopressin Prevents Hypotension but Impairs Cerebral Oxygenation During Arthroscopic Shoulder Surgery in the Beach Chair Position

Cho, Soo Y.; Kim, Seok J.; Jeong, Chaehwan; Jeong, Chul; Chung, Seung Min; Lee, Jong-Un; Yoo, Kyung Yeon

doi:10.1213/ane.0b013e3182a8fa97

Cited by 28 publications

(53 citation statements)

References 37 publications

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“…Some data suggest that this drug and other vasoconstrictors may reduce rScO 2 measured with NIRS. 51,52 Since scalp blood flow is not autoregulated and because COx measures the relationship between low-frequency changes in rScO 2 and blood pressure, the effects of phenylephrine on NIRS measurements, if any, seem minimal.…”

Section: Discussionmentioning

confidence: 99%

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Laflam¹,

Joshi

Brady

et al. 2015

Anesthesia &Amp; Analgesia

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Background Although controversial, failing to consider the gravitational effects of head elevation on cerebral perfusion is speculated to increase susceptibility to rare, but devastating, neurologic complications after shoulder surgery in the beach chair position (BCP). We hypothesized that patients in the BCP have diminished cerebral blood flow autoregulation than those who undergo surgery in the lateral decubitus position (LDP). A secondary aim was to examine whether there is a relationship between patient positioning during surgery and postoperative cognition or serum brain injury biomarker levels. Methods Patients undergoing shoulder surgery in the BCP (n=109) or LDP (n=109) had mean arterial blood pressure (MAP) and regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy. A continuous, moving Pearson’s correlation coefficient was calculated between MAP and rScO2, generating the variable cerebral oximetry index (COx). When MAP is in the autoregulated range, COx approaches zero because there is no correlation between cerebral blood flow and arterial blood pressure. In contrast, when MAP is below the limit of autoregulation, COx is higher because there is a direct relationship between lower arterial blood pressure and lower cerebral blood flow. Thus, diminished autoregulation would be manifest as higher COx. Psychometric testing was performed before surgery and then 7–10 days and 4–6 weeks after surgery. A composite cognitive outcome was determined as the Z-score. Serum S100β, neuron-specific enolase, and glial fibrillary acidic protein were measured at baseline, after surgery, and on postoperative day 1. Results After adjusting for age and history of hypertension, COx (p=0.035) was higher and rScO2 lower (p<0.0001) in the BCP group than in the LDP group. After adjusting for baseline composite cognitive outcome, there was no difference in Z-score 7 to 10 day (p=0.530) or 4 to 6 weeks (p=0.202) after surgery between the BCP and the LDP groups. There was no difference in serum biomarker levels between the 2 position groups Conclusions Compared with patients in the LDP, patients undergoing shoulder surgery in the BCP are more likely to have higher COx indicating diminished cerebral autoregulation and lower rScO2. There were no differences in the composite cognitive outcome between the BCP and LDP groups after surgery after accounting for baseline Z-score.

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Section: Discussionmentioning

confidence: 99%

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Laflam¹,

Joshi

Brady

et al. 2015

Anesthesia &Amp; Analgesia

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“…Third, phenylephrine yields higher cerebral perfusion pressure in patients with traumatic brain injury compared with dopamine and norepinephrine, suggesting the desirable property of this vasoconstrictor agent in the cerebral circulation [22]. It is crucial to note that another vasoconstrictor agent vasopressin reduces cerebral oxygenation during the beach chair position despite the mean blood pressure elevation [4]. These results suggest that phenylephrine is probably one of the most valuable vasopressors, which are available in the clinical practice, to preserve cerebral oxygenation during anesthesia in the beach chair position.…”

Section: Discussionmentioning

confidence: 99%

“…However, a possible decrease in cerebral oxygenation related to this position has been suggested by many previous reports, although exact mechanisms of the catastrophic complication remain to be determined [2][3][4].…”

Section: Introductionmentioning

confidence: 86%

Cerebral oxygenation in the beach chair position before and during general anesthesia in patients with and without cardiovascular risk factors

Mori

Yamada

Akahori

et al. 2015

Journal of Clinical Anesthesia

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“…It has been stated that mean arterial blood pressure (MAP) should be targeted within 15-20% of baseline during upright positioning [23]. However, some studies observed cerebral desaturation despite maintaining blood pressure with phenylephrine [24] or vasopressin [25]. The effect of general anesthesia was compared with regional anesthesia and sedation (awake group) during BCP [26].…”

Section: Key Pointsmentioning

confidence: 99%

Cerebral oximetry

Moerman

Hert

2015

Current Opinion in Anaesthesiology

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Under General Anesthesia Arginine Vasopressin Prevents Hypotension but Impairs Cerebral Oxygenation During Arthroscopic Shoulder Surgery in the Beach Chair Position

Abstract: A prophylactic bolus administration of AVP prevents hypotension associated with BCP in patients undergoing shoulder surgery under general anesthesia. However, it was associated with regional cerebral but not jugular venous oxygen desaturation on upright positioning.

Cited by 28 publications

References 37 publications

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Shoulder Surgery in the Beach Chair Position Is Associated with Diminished Cerebral Autoregulation but No Differences in Postoperative Cognition or Brain Injury Biomarker Levels Compared with Supine Positioning

Cerebral oxygenation in the beach chair position before and during general anesthesia in patients with and without cardiovascular risk factors

Cerebral oximetry

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