Journal article
Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome.
- Aguirre JA Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: jose.aguirre@balgrist.ch.
- Märzendorfer O Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: oliviam@access.uzh.ch.
- Brada M Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: Muriel.brada@balgrist.ch.
- Saporito A Anaesthesiology Department, Bellinzona Regional Hospital, Bellinzona, Switzerland. Electronic address: Andrea.Saporito@eoc.ch.
- Borgeat A Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: alain.borgeat@balgrist.ch.
- Bühler P Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: karlphilippbuehler@gmail.com.
- 2016-11-23
Published in:
- Journal of clinical anesthesia. - 2016
Beach chair position, neurocognitive outcome
Cerebral blood flow
Cerebral oxygenation
Intraoperative monitoring
Near-infrared spectroscopy
Adult
Anesthesia, Conduction
Brain
Cerebrovascular Circulation
Female
Humans
Male
Middle Aged
Neurocognitive Disorders
Oxygen
Patient Positioning
Postoperative Complications
Posture
Prospective Studies
Shoulder
English
STUDY OBJECTIVE
Beach chair position is considered a potential risk factor for central neurological events particularly if combined with low blood pressure. The aim of this study was to assess the impact of regional anesthesia on cerebral blood flow and neurobehavioral outcome.
DESIGN
This is a prospective, assessor-blinded observational study evaluating patients in the beach chair position undergoing shoulder surgery under regional anesthesia.
SETTING
University hospital operating room.
PATIENTS
Forty patients with American Society of Anesthesiologists classes I-II physical status scheduled for elective shoulder surgery.
INTERVENTIONS
Cerebral saturation and blood flow of the middle cerebral artery were measured prior to anesthesia and continued after beach chair positioning until discharge to the postanesthesia care unit. The anesthesiologist was blinded for these values. Controlled hypotension with systolic blood pressure≤100mm Hg was maintained during surgery.
MEASUREMENTS
Neurobehavioral tests and values of regional cerebral saturation, bispectral index, the mean maximal blood flow of the middle cerebral artery, and invasive blood pressure were measured prior to regional anesthesia, and measurements were repeated after placement of the patient on the beach chair position and every 20 minutes thereafter until discharge to postanesthesia care unit. The neurobehavioral tests were repeated the day after surgery.
MAIN RESULTS
The incidence of cerebral desaturation events was 5%. All patients had a significant blood pressure drop 5 minutes after beach chair positioning, measured at the heart as well as the acoustic meatus levels, when compared with baseline values (P<.05). There was no decrease in either the regional cerebral saturation (P=.136) or the maximal blood flow of the middle cerebral artery (P=.212) at the same time points. Some neurocognitive tests showed an impairment 24 hours after surgery (P<.001 for 2 of 3 tests).
CONCLUSIONS
Beach chair position in patients undergoing regional anesthesia for shoulder surgery had no major impact on cerebral blood flow and cerebral oxygenation. However, some impact on neurobehavioral outcome 24 hours after surgery was observed.
Beach chair position is considered a potential risk factor for central neurological events particularly if combined with low blood pressure. The aim of this study was to assess the impact of regional anesthesia on cerebral blood flow and neurobehavioral outcome.
DESIGN
This is a prospective, assessor-blinded observational study evaluating patients in the beach chair position undergoing shoulder surgery under regional anesthesia.
SETTING
University hospital operating room.
PATIENTS
Forty patients with American Society of Anesthesiologists classes I-II physical status scheduled for elective shoulder surgery.
INTERVENTIONS
Cerebral saturation and blood flow of the middle cerebral artery were measured prior to anesthesia and continued after beach chair positioning until discharge to the postanesthesia care unit. The anesthesiologist was blinded for these values. Controlled hypotension with systolic blood pressure≤100mm Hg was maintained during surgery.
MEASUREMENTS
Neurobehavioral tests and values of regional cerebral saturation, bispectral index, the mean maximal blood flow of the middle cerebral artery, and invasive blood pressure were measured prior to regional anesthesia, and measurements were repeated after placement of the patient on the beach chair position and every 20 minutes thereafter until discharge to postanesthesia care unit. The neurobehavioral tests were repeated the day after surgery.
MAIN RESULTS
The incidence of cerebral desaturation events was 5%. All patients had a significant blood pressure drop 5 minutes after beach chair positioning, measured at the heart as well as the acoustic meatus levels, when compared with baseline values (P<.05). There was no decrease in either the regional cerebral saturation (P=.136) or the maximal blood flow of the middle cerebral artery (P=.212) at the same time points. Some neurocognitive tests showed an impairment 24 hours after surgery (P<.001 for 2 of 3 tests).
CONCLUSIONS
Beach chair position in patients undergoing regional anesthesia for shoulder surgery had no major impact on cerebral blood flow and cerebral oxygenation. However, some impact on neurobehavioral outcome 24 hours after surgery was observed.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jclinane.2016.08.035
- PMID 27871574
- Persistent URL
- https://folia.unifr.ch/global/documents/266429
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