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Lee CT, Lin CP, Chan KC, Wu YL, Teng HC, Wu CY. Effects of Goal-Directed Hemodynamic Therapy Using a Noninvasive Finger-Cuff Monitoring Device on Intraoperative Cerebral Oxygenation and Early Delayed Neurocognitive Recovery in Patients Undergoing Beach Chair Position Shoulder Surgery: A Randomized Controlled Trial. Anesth Analg 2023; 136:355-364. [PMID: 36135341 DOI: 10.1213/ane.0000000000006200] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Perioperative cerebral desaturation events (CDEs) and delayed neurocognitive recovery are common among patients undergoing beach chair position (BCP) shoulder surgery and may be caused by cerebral hypoperfusion. This study tested the hypothesis that the application of goal-directed hemodynamic therapy (GDHT) would attenuate these conditions. METHODS We randomly assigned 70 adult patients undergoing BCP shoulder surgery to GDHT group or control at a 1:1 ratio. Cerebral oxygenation was monitored using near-infrared spectroscopy, and GDHT was administered using the ClearSight pulse wave analysis system. The primary outcome was CDE duration, whereas the secondary outcomes were CDE occurrence, delayed neurocognitive recovery occurrence, and Taiwanese version of the Quick Mild Cognitive Impairment (Qmci-TW) test score on the first postoperative day (T 2 ) adjusted for the baseline score (on the day before surgery; T 1 ). RESULTS CDE duration was significantly shorter in the GDHT group (0 [0-0] vs 15 [0-75] min; median difference [95% confidence interval], -8 [-15 to 0] min; P = .007). Compared with the control group, fewer patients in the GDHT group experienced CDEs (23% vs 51%; relative risk [95% confidence interval], 0.44 [0.22-0.89]; P = .025) and mild delayed neurocognitive recovery (17% vs 40%; relative risk [95% confidence interval], 0.60 [0.39-0.93]; P = .034). The Qmci-TW scores at T 2 adjusted for the baseline scores at T 1 were significantly higher in the GDHT group (difference in means: 4 [0-8]; P = .033). CONCLUSIONS Implementing GDHT using a noninvasive finger-cuff monitoring device stabilizes intraoperative cerebral oxygenation and is associated with improved early postoperative cognitive scores in patients undergoing BCP shoulder surgery.
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Affiliation(s)
- Chen-Tse Lee
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chih-Peng Lin
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuang-Cheng Chan
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Luen Wu
- Department of Medical Education, National Taiwan University, Taipei, Taiwan
| | - Hsiao-Chun Teng
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Yu Wu
- From the Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
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Fukada T, Tsuchiya Y, Iwakiri H, Ozaki M, Nomura M. Forehead Regional Oxygen Saturation (rSO2)-Related Ear-Level Arterial Pressure and Lower Thigh rSO2 in the Steep Trendelenburg Position with CO2 Pneumoperitoneum and the Beach Chair Position. Cureus 2021; 13:e15687. [PMID: 34277276 PMCID: PMC8284083 DOI: 10.7759/cureus.15687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/14/2022] Open
Abstract
Introduction Regional oxygen saturation (rSO2) reflects tissue perfusion. This observational study aimed to examine the change in the forehead and lower thigh rSO2 associated with intraoperative posture, anesthesia regimen, or mean arterial pressure (mAP) at heart and external auditory meatus (ear) levels. Methods Patients undergoing robot-assisted laparoscopic radical prostatectomy in the Trendelenburg position at 30° with pneumoperitoneum (TPP) or arthroscopic shoulder surgery in the beach chair position at 70° (BCP) under desflurane-remifentanil (D/R) or propofol-remifentanil (P/R) anesthesia were examined. Bilateral forehead and lower thigh rSO2 values and mean radial artery pressure were measured simultaneously at heart and ear levels. Results In TPP, there were no differences under anesthesia regimens in the forehead or lower thigh rSO2change, although one patient with an absolute lower thigh rSO2 of ≤50% in the lithotomy position complained of transient limb pain. No correlation was observed between rSO2 and mAP. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased under either of the anesthesia regimens. The coefficient of correlation between forehead rSO2 andheart-level and ear-level mAP was 0.341 and 0.236, respectively. Conclusions There were no differences under anesthesia regimens in the changes of forehead rSO2 and lower thigh rSO2. In TPP, significant changes in forehead rSO2 and lower thigh rSO2 were not observed. Monitoring lower thigh rSO2 might be useful for preventing lower extremity pain. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased from the supine position to the BCP. To prevent brain damage, anesthesiologists should pay attention to heart- and ear-level mAP.
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Affiliation(s)
- Tomoko Fukada
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Yuri Tsuchiya
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Hiroko Iwakiri
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Makoto Ozaki
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
| | - Minoru Nomura
- Department of Anesthesiology, Tokyo Women's Medical University, School of Medicine, Tokyo, JPN
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Tantry TP, Karanth H, Koteshwar R, Shetty PK, Adappa KK, Shenoy SP, Kadam D, Bhandary S. Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations. Indian J Anaesth 2020; 64:653-667. [PMID: 32934399 PMCID: PMC7457979 DOI: 10.4103/ija.ija_228_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 07/07/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Aims Evaluations of adverse heart rate (HR)-responses and HR-variations during anaesthesia in beach-chair-position (BCP) for shoulder surgeries have not been done earlier. We analysed the incidence, associations, and interpretations of adverse HR-responses in this clinical setting. Methods We performed a meta-analysis of trials that reported HR-related data in anaesthetised subjects undergoing elective shoulder surgeries in BCP. Studies included prospective, randomised, quasi-randomised and non-randomised, controlled clinical trials as well as observational cohorts. Literature search was conducted in MEDLINE, EMBASE, CINHAL and the Cochrane Central Register of Controlled Trials of the 21st century. In the first analysis, we studied the incidence and associations of bradycardia/hypotension-bradycardia episodes (HBE) with respect to the type of anaesthesia and different pharmacological agents. In the second, we evaluated anaesthetic influences, associations and inter-relationships between monitored parameters with respect to HR-behaviours. Results Among the trials designed with bradycardia/HBE as a primary end point, the observed incidence of bradycardia was 9.1% and that of HBE, 14.9% and 22.7% [(for Interscalene block (ISB) ± sedation) subjects and general anaesthesia (GA) + ISB, respectively]. There was evidence of higher observed risk of developing adverse HR-responses for GA subjects over ISB (Risk Difference, P < 0.05). Concomitant use of β-agonists did not increase risk of HBEs (P = 0.29, I 2= 11.4%) or with fentanyl (P = 0.45, I 2= 0%) for ISB subjects (subgroup analysis). Fentanyl significantly influenced the HR-drop over time [meta-regression, estimates (standard error), 14.9 (5.4), 9.8 (4.3) and 17 (2.6); P = 0.007, 0.024 and <0.001; for early, mid and delayed periods, respectively] in GA subjects. With respect to number of subjects experiencing cerebral desaturation events (CDEs), total intravenous anaesthesia (TIVA)- propofol had higher risk over inhalational anaesthesia (P = 0.006, I 2 = 86.7%). Meta-correlation analysis showed relationships between the HR and rSO2(regional cerebral oxygen saturation) or SjvO2(jugular venous oxygen saturation) values (r = 0.608, 95%CI, 0.439 to 0.735, P < 0.001, I 2= 77.4% and r = 0.397, 95%CI, 0.151 to 0.597, P < 0.001, I 2= 64.3%, respectively). Conclusions There is not enough evidence to claim the associations of adverse HR-responses with any specific factor. HR-fall is maximal with fentanyl and its variability is associated with changes in rSO2. Fall in rSO2 could be the common link triggering adverse HR-responses in BCP.
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Affiliation(s)
- Thrivikrama Padur Tantry
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Harish Karanth
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Reshma Koteshwar
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Pramal K Shetty
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Karunakara K Adappa
- Department of Anaesthesiology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Sunil P Shenoy
- Department of Urology, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Dinesh Kadam
- Department of Plastic and Reconstructive Surgery, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
| | - Sudarshan Bhandary
- Department of Orthopedics, Arthroscopy and Sports Medicine, A J Institute of Medical Sciences and Research Centre, Kuntikana, Mangalore, Karnataka, India
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Murphy GS, Greenberg SB, Szokol JW. Safety of Beach Chair Position Shoulder Surgery. Anesth Analg 2019; 129:101-118. [DOI: 10.1213/ane.0000000000004133] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Orebaugh S, Palmeri S, Lin C, YaDeau J. Daring discourse: is nerve block with sedation the safest anesthetic for beach chair position? Reg Anesth Pain Med 2019; 44:707-712. [PMID: 30928909 DOI: 10.1136/rapm-2018-100230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Steven Orebaugh
- Anaesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Shawn Palmeri
- Anaesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Charles Lin
- Anaesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jacques YaDeau
- Anesthesiology, Hospital for Special Surgery, Weill Cornell Medical College, New York City, New York, USA
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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. J Clin Anesth 2018; 53:40-48. [PMID: 30292739 DOI: 10.1016/j.jclinane.2018.09.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/05/2018] [Accepted: 09/29/2018] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to assess the impact of intravenous general anesthesia and controlled hypotension on cerebral saturation (rScO2), cerebral blood flow measured as middle cerebral artery blood flow velocity (Vmax MCA) and neurobehavioral outcome in patients scheduled for shoulder surgery in beach chair position. DESIGN Prospective, assessor-blinded observational study. SETTING University hospital, shoulder surgery operating room. PATIENTS Forty ASA I-II patients scheduled for shoulder surgery in beach chair position and controlled hypotension. INTERVENTIONS Neurological and neurobehavioral tests were performed prior and the day after surgery. The baseline data for near-infrared spectroscopy, bispectral index, cerebral blood flow, PaCO2 and invasive blood pressure (radial artery) were taken prior anesthesia and after anesthesia induction, after beach chair positioning and all 20 min after surgery start until discharge of the patient. MEASUREMENTS Neurological and neurobehavioral tests, cerebral saturation (rScO2) using near-infrared spectroscopy, BIS, cerebral blood flow using Doppler of the middle cerebral artery (Vmax MCA), PaCO2 and invasive blood pressure assessed at heart and at the external acoustic meatus level. MAIN RESULTS The incidence of cerebral desaturation events (CDEs) was 25%. The blood pressure drop 5 min after beach chair position measured at the acoustic meatus level in the CDE group was higher compared to patients without CDEs (p = 0.009) as was the rScO2 (p = 0.039) and the Vmax MCA (p = 0.002). There were no neurological deficits but patients with CDEs showed a greater negative impact on neurobehavioral tests 24 h after surgery compared to patients without CDEs (p = 0.001). CONCLUSIONS In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with impact on the neurobehavioral outcome.
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Haršanji Drenjančević I, Drenjančević D, Davidović-Cvetko E, Drenjančević I, Gulam D, Kvolik S. DOES THE ANESTHESIA TECHNIQUE AFFECT ARTERIAL PRESSURE AND REGIONAL CEREBRAL OXYGEN SATURATION DURING SHOULDER ARTHROSCOPY IN THE BEACH CHAIR POSITION? Acta Clin Croat 2018; 57:473-479. [PMID: 31168180 PMCID: PMC6536278 DOI: 10.20471/acc.2018.57.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
- This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.
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Affiliation(s)
| | - Domagoj Drenjančević
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Erna Davidović-Cvetko
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Ines Drenjančević
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Danijela Gulam
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
| | - Slavica Kvolik
- 1Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek University Hospital Centre and Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 2Department of Transfusion Medicine, Osijek University Hospital Centre and Department of Microbiology and Parasitology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 3Lavoslav Ružička College of Applied Sciences of Vukovar, Vukovar, Croatia; 4Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; 5Department of Anesthesiology, Resuscitation and Intensive Medicine, Split University Hospital Centre, Split, Croatia
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Aguirre JA, Märzendorfer O, Brada M, Saporito A, Borgeat A, Bühler P. Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome. J Clin Anesth 2016; 35:456-464. [DOI: 10.1016/j.jclinane.2016.08.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/09/2016] [Accepted: 08/14/2016] [Indexed: 10/20/2022]
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9
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Thomas W, Thomas TS, Tafuro L, Walter S. Treating Rotator Cuff Tears Through a Coracoacromial Mini-Open Approach. Arthrosc Tech 2016; 5:e1023-e1027. [PMID: 27909670 PMCID: PMC5124062 DOI: 10.1016/j.eats.2016.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/17/2016] [Indexed: 02/03/2023] Open
Abstract
The purpose of this study is to present a "smart," open, minimally invasive surgical technique for rotator cuff repair of the shoulder. On the basis of an anatomic study by Tichy, we use a coracoacromial mobile window: We split-not detach-the deltoid muscle by respecting its fibers' orientation and resect the coracoacromial ligament before repairing the torn rotator cuff tendons with anchors. The described approach is fast, is technically uncomplicated, and can be carried out with a standard set of instruments. In cases of rotator cuff tears for which arthroscopic treatment would be very demanding, as well as in situations in which there are technical problems and/or limited access to arthroscopic equipment, this approach may serve as a backup strategy.
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Affiliation(s)
| | | | | | - Sebastian Walter
- Address correspondence to Sebastian Walter, M.D., M.Sc., European Hospital, Via Portuense 700, 00149 Rome, Italy.European HospitalVia Portuense 70000149 RomeItaly
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Buget MI, Atalar AC, Edipoglu IS, Sungur Z, Sivrikoz N, Karadeniz M, Saka E, Kucukay S, Senturk MN. Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position. Braz J Anesthesiol 2016; 66:470-4. [PMID: 27591460 DOI: 10.1016/j.bjane.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/13/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. METHODS 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients' internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4)min. RESULTS There was a significant decrease between T0 and T1 in heart rate (80.5±11.6 vs. 75.9±14.4beats/min), MAP (105.8±21.9 vs. 78.9±18.4mmHg) and PSI (88.5±8.3 vs. 30.3±9.7) (all p<0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. CONCLUSION Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20min.
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Affiliation(s)
- Mehmet Ilke Buget
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey.
| | - Ata Can Atalar
- İstanbul University, Istanbul Medical Faculty, Department of Orthopedics and Traumatology, İstanbul, Turkey
| | - Ipek Saadet Edipoglu
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Zerrin Sungur
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Nukhet Sivrikoz
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Meltem Karadeniz
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Esra Saka
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Suleyman Kucukay
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
| | - Mert N Senturk
- İstanbul University, Istanbul Medical Faculty, Department of Anaesthesiology, İstanbul, Turkey
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Buget MI, Atalar AC, Edipoglu IS, Sungur Z, Sivrikoz N, Karadeniz M, Saka E, Kucukay S, Senturk MN. Patient State Index e alterações do fluxo sanguíneo cerebral durante artroscopia do ombro em posição de cadeira de praia. Braz J Anesthesiol 2016; 66:470-4. [DOI: 10.1016/j.bjan.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 02/13/2015] [Indexed: 10/21/2022] Open
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Soeding PF, Currigan DA, Mamo Y, Hoy G. Effect of interscalene anaesthesia on cerebral oxygen saturation. Anaesth Intensive Care 2016; 44:359-63. [PMID: 27246935 DOI: 10.1177/0310057x1604400301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Interscalene blockade (ISB) is commonly associated with Horner's syndrome, indicating spread of injectate to the cervical sympathetic chain. Cervical sympathetic nerve activity (SNA) is believed to influence cerebral autoregulation, and a decrease in sympathetic tone may alter cerebral blood flow (CBF). This study investigated whether ISB influenced CBF in patients undergoing shoulder surgery. Patients (n=30) scheduled for elective shoulder arthroscopy were recruited. Cerebral oxygen saturation (ScO(2)) of the left and right frontal cortices was continuously measured during ISB administration, sedation and anaesthetic induction. Baseline ScO(2) was similar in blocked and unblocked sides (74 ± 5% and 73 ± 5% respectively, P=0.70). ScO(2) decreased with sedation (-3 ± 3% and -4 ± 3%, P=0.93), and increased with pre-oxygenation and general anaesthesia (P <0.01). Following ISB there was no change in ScO(2) between blocked and unblocked sides (P=0.18), or any difference between right- or left-sided ISB. ISB is not associated with an increase in CBF as indicated by ScO(2), despite the presence of Horner's syndrome.
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Affiliation(s)
- P F Soeding
- Visiting Anaesthetist, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, and Associate Professor, Department of Pharmacology, University of Melbourne, Melbourne, Victoria
| | - D A Currigan
- Fellow, Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria
| | - Y Mamo
- Cardiovascular Therapeutics Unit, Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria
| | - G Hoy
- Specialist Surgeon, Melbourne Orthopaedic Group, Windsor, Victoria
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Lahaye L, Grasso M, Green J, Biddle CJ. Cerebral tissue O2 saturation during prolonged robotic surgery in the steep Trendelenburg position: an observational case series in a diverse surgical population. J Robot Surg 2015; 9:19-25. [PMID: 26530967 DOI: 10.1007/s11701-014-0483-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 08/03/2014] [Indexed: 11/29/2022]
Abstract
Demands associated with the Trendelenburg position (TP) are well known yet there is little attention given to regional cerebral tissue O2 saturation (SctO2) in those undergoing robotic surgery in the TP with CO2 insufflation (C-INSF). This is the first study to report on SctO2 in a wide range of patients undergoing lengthy TP and robotic surgery. We measured SctO2 during robotic surgery in patients in the TP with C-INSF, as well as a control robotic thyroid surgery group who were supine with no C-INSF. We recorded relevant variables and periods of cerebral desaturation (CD). We studied 42 patients in 25°-45° of TP for ≥125 min. Management was at the providers' discretion. The INVOS(®) 5100C Cerebral Oximeter (Covidien, Boulder, CO) recorded SctO2. CD was defined as a >20 % decrease from baseline SctO2 or a value ≤55 % for ≥10 min. Patients were assessed for adverse outcome. The sample consisted of 13 males and 29 females aged 22-73, BMI 22-36 had general (N = 3), urological (N = 14) and gynecological (N = 25) surgery; two patients had CD lasting 150 and 190 min and two had episodic CD lasting 10-35 min. The four were female aged 22-60 in 38°-45° of TP. Eleven cases had multiple episodic CD for ≤15 min, 27 TP cases had no CD. Other observations included a consistent fall in SctO2 with phenylephrine; an increased SctO2 with ephedrine; and FiO2 and EtCO2 being generally strong, direct modifiers of SctO2. High MAP was inconsistently associated with high SctO2. BMI had no observed effect on SctO2. Pulse oximetry was ≥97 % in all cases. We observed no adverse cerebral events on follow-up. Additional clinical studies are warranted.
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Affiliation(s)
- Laura Lahaye
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Mario Grasso
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jeffrey Green
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - C J Biddle
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
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A comparison of the lateral decubitus and beach-chair positions for shoulder surgery: advantages and complications. J Am Acad Orthop Surg 2015; 23:18-28. [PMID: 25538127 DOI: 10.5435/jaaos-23-01-18] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Arthroscopic or open shoulder surgery can be performed using the lateral decubitus or beach-chair position. Advantages of the lateral decubitus position include better visualization and instrument access for certain procedures and decreased risk for cerebral hypoperfusion. Complications associated with this position include traction injuries, resulting in neurapraxia, thromboembolic events, difficulty with airway management, and the potential need to convert to an anterior open approach. One advantage of the beach-chair position is easier setup from a supine to upright position, which allows the surgeon the option to convert to an open procedure if necessary. Although rare, patients in this position may experience cerebral hypoperfusion and complications that range from cranial nerve injury to infarction. Other complications related to this position include cervical traction neurapraxia, blindness, and cardiac and embolic events. The surgeon must be cognizant of the complications associated with both positions and take extra care in the initial patient setup and coordination with the anesthesiologist to minimize the risk of complications and morbidity.
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Triplet JJ, Lonetta CM, Everding NG, Moor MA, Levy JC. Association between temporal mean arterial pressure and brachial noninvasive blood pressure during shoulder surgery in the beach chair position during general anesthesia. J Shoulder Elbow Surg 2015; 24:127-32. [PMID: 25174938 DOI: 10.1016/j.jse.2014.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND Estimation of cerebral perfusion pressure during elective shoulder surgery in the beach chair position is regularly performed by noninvasive brachial blood pressure (NIBP) measurements. The relationship between brachial mean arterial pressure and estimated temporal mean arterial pressure (eTMAP) is not well established and may vary with patient positioning. Establishing a ratio between eTMAP and NIBP at varying positions may provide a more accurate estimation of cerebral perfusion using noninvasive measurements. METHODS This prospective study included 57 patients undergoing elective shoulder surgery in the beach chair position. All patients received an interscalene block and general anesthesia. After the induction of general anesthesia, values for eTMAP and NIBP were recorded at 0°, 30°, and 70° of incline. RESULTS A statistically significant, strong, and direct correlation between NIBP and eTMAP was found at 0° (r = 0.909, P ≤ .001), 30° (r = 0.874, P < .001), and 70° (r = 0.819, P < .001) of incline. The mean ratios of eTMAP to NIBP at 0°, 30°, and 70° of incline were 0.939 (95% confidence interval [CI], 0.915-0.964), 0.738 (95% CI, 0.704-0.771), and 0.629 (95% CI, 0.584-0.673), respectively. There was a statistically significant decrease in the eTMAP/NIBP ratio as patient incline increased from 0° to 30° (P < .001) and from 30° to 70° (P < .001). CONCLUSION The eTMAP-to-NIBP ratio decreases as an anesthetized patient is placed into the beach chair position. Awareness of this phenomenon is important to ensure adequate cerebral perfusion and prevent hypoxic-related injuries.
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Affiliation(s)
- Jacob J Triplet
- Nova Southeastern University, College of Osteopathic Medicine, Fort Lauderdale, FL, USA.
| | | | | | - Molly A Moor
- Holy Cross Orthopedic Institute, Fort Lauderdale, FL, USA
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The effect of desflurane versus propofol on regional cerebral oxygenation in the sitting position for shoulder arthroscopy. J Clin Monit Comput 2013; 28:371-6. [DOI: 10.1007/s10877-013-9543-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: comparing general to regional anesthesia and the impact on neurobehavioral outcome. ACTA ACUST UNITED AC 2013; 61:64-72. [PMID: 24119783 DOI: 10.1016/j.redar.2013.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ischemic brain damage has been reported in healthy patients after beach chair position for surgery due to cerebral hypoperfusion. Near-infrared spectroscopy has been described as a non-invasive, continuous method to monitor cerebral oxygen saturation. However, its impact on neurobehavioral outcome comparing different anesthesia regimens has been poorly described. METHODS In this prospective, assessor-blinded study, 90 patients undergoing shoulder surgery in beach chair position following general (G-group, n=45) or regional anesthesia (R-group; n=45) were enrolled to assess the prevalence of cerebral desaturation events comparing anesthesia regimens and their impact on neurobehavioral and neurological outcome. Anesthesiologists were blinded to regional cerebral oxygen saturation values. Baseline data assessed the day before surgery included neurological and neurobehavioral tests, which were repeated the day after surgery. The baseline data for regional cerebral oxygen saturation/bispectral index and invasive blood pressure both at heart and auditory meatus levels were taken prior to anesthesia, 5 min after induction of anesthesia, 5 min after beach chair positioning, after skin incision and thereafter all 20 min until discharge. RESULTS Patients in the R-group showed significantly less cerebral desaturation events (p<0.001), drops in regional cerebral oxygen saturation values (p<0.001), significantly better neurobehavioral test results the day after surgery (p<0.001) and showed a greater hemodynamic stability in the beach chair position compared to patients in the G-group. CONCLUSIONS The incidence of regional cerebral oxygen desaturations seems to influence the neurobehavioral outcome. Regional anesthesia offers more stable cardiovascular conditions for shoulder surgery in beach chair position influencing neurobehavioral test results at 24h.
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Jo YY, Jung WS, Kim HS, Chang YJ, Kwak HJ. Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables. J Clin Monit Comput 2013; 28:173-8. [DOI: 10.1007/s10877-013-9512-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Soeding P, Hoy S, Hoy G, Evans M, Royse C. Effect of phenylephrine on the haemodynamic state and cerebral oxygen saturation during anaesthesia in the upright position. Br J Anaesth 2013; 111:229-34. [DOI: 10.1093/bja/aet024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pin-on P, Schroeder D, Munis J. The Hemodynamic Management of 5177 Neurosurgical and Orthopedic Patients Who Underwent Surgery in the Sitting or “Beach Chair” Position Without Incidence of Adverse Neurologic Events. Anesth Analg 2013; 116:1317-24. [DOI: 10.1213/ane.0b013e31828446bb] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Outcomes of Shoulder Surgery in the Sitting Position With Interscalene Nerve Block. Reg Anesth Pain Med 2013; 38:28-33. [PMID: 23222361 DOI: 10.1097/aap.0b013e318277a2eb] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Villevieille T, Delaunay L, Gentili M, Benhamou D. Chirurgie arthroscopique de l’épaule et complications ischémiques cérébrales. ACTA ACUST UNITED AC 2012; 31:914-8. [DOI: 10.1016/j.annfar.2012.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
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Ko SH, Cho YW, Park SH, Jeong JG, Shin SM, Kang G. Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position. Korean J Anesthesiol 2012; 63:297-301. [PMID: 23115680 PMCID: PMC3483486 DOI: 10.4097/kjae.2012.63.4.297] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 04/26/2012] [Accepted: 05/15/2012] [Indexed: 11/26/2022] Open
Abstract
Background Cerebral hypotension and desaturation can occur during shoulder surgery in the seated position. We evaluated the correlation of cerebral oxygen saturation (rSO2) using near infra-red spectroscopy (NIRS) and mean arterial pressures (MAP) (at the levels of the brain and heart). Methods Fifty patients, scheduled for the arthroscopic shoulder surgery in the seated position, were enrolled to monitor the rSO2, bispectral Index (BIS), and MAPs at the levels of the brain and heart. The values of each parameter were collected at 5 min after intubation, immediately after placing the patient in the sitting position, 5 min after the patient was seated, immediately after the surgical incision, and every 30 min after incision. Results A correlation between the cerebral rSO2 and the MAP at the level of brain were statistically significant. Cerebral rSO2 and MAP after a change of posture from supine to sitting position were significantly decreased, compared to the baseline value. Conclusions Monitoring cerebral rSO2 and MAP at the level of brain can be helpful to detect the possibility of cerebral deoxygenation earlier.
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Affiliation(s)
- Sang-Hun Ko
- Department of Orthopedic Surgery, Ulsan University Hospital, College of Medicine, University of Ulsan, Ulsan, Korea
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