A cardiovascular collapse occurred in the beach chair position for shoulder arthroscopy under general anesthesia -A case report-

Abstract

The occurrence of severe hypotension and bradycardia, following placing to the beach chair position from supine during general anesthesia for repair of tendon injury of the rotator cuff of shoulder in a healthy 50 year-old man was described. The Bezold-Jarisch reflex, which is known to inhibit cardiovascular reflex and composed of three kinds of symptoms such as vasodilation, bradycardia and hypotension, has been reported mainly in peripheral nerve block, and may occur during orthostasis, hypovolemia, hemorrhage, supine inferior vena cava compression in pregnancy, interscalene block for shoulder surgery in the sitting position and so on. The bradycardia and hypotension can be more aggravated when causative elements overlaps each other. Anticholinergics and vasopressor were injected intravenously, and position of the patient was changed to the supine position immediately resulting in a normal vital signs dramatically.

Effects of intraoperative hypotension on postoperative renal function in arthroscopic shoulder surgery: a retrospective study

“…In fact, there have been many reports of complications related to brain function associated with surgery in the beach chair position. Significant hypotension can lead to cerebral hypoperfusion and neurological complications, such as cerebral ischemia, pituitary apoplexy, and cardiovascular collapse [7][8][9]. To prevent these complications, some studies used sequential compression devices [13] or attempted intravenous bolus administration of arginine vasopressin [14].…”

“…Arthroscopic shoulder surgery tends to cause a drop in blood pressure due to the beach chair position, including activation of the Bezold-Jarisch reflex [6]. Significant hypotension can lead to cerebral hypoperfusion and neurological complications, such as cerebral ischemia, pituitary apoplexy, and cardiovascular collapse [7][8][9]. However, the kidneys are located below the heart when in the beach chair position, and it is assumed that renal blood flow can be maintained relatively easily compared to the blood pressure (as measured at the upper arm) due to gravity.…”

Effect of an epinephrine mixture for interscalene block on hemodynamic changes after the beach chair position under general anesthesia: a retrospective study

“…Several reports have shown severe hypotension and bradycardia immediately after placing patients in a sitting position under general anesthesia [216], which cannot be explained by the BJR associated with epinephrine. Rather, preventive epinephrine is thought to be helpful in these events.…”

“…However, risks include significant hypotension, which can lead to cerebral hypoperfusion and neurological complications; cerebral ischemia, cranial nerve neuropraxia, pituitary apoplexy, and cardiovascular collapse have been reported [2345]. …”

Cerebral desaturation events in the beach chair position: correlation of noninvasive blood pressure and estimated temporal mean arterial pressure

“…1,8,10,20 Such reported injuries include blindness, 2 neurapraxia of the cranial nerves, 7 pituitary apoplexy, 12 cardiovascular collapse, 23 and death. 8 Consequently, reports have cited the beach chair position as an independent risk factor for cerebral ischemia during surgery.…”