Blood pressure management during beach chair position shoulder surgery: What do we know?

Murphy, Glenn S.; Szokol, Joseph W.

doi:10.1007/s12630-011-9573-8

Cited by 22 publications

(14 citation statements)

References 12 publications

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“…This calculated value was the same as the value that was directly recorded in the radial artery in our study (approximately 81 mmHg). In a conscious, healthy individuals, the cerebral blood flow is maintained at a constant level of between 50 (recently 70 has been proposed) and 150 mmHg, despite changes in the cerebral perfusion pressure [11] [18]. Reports indicate that cerebral autoregulation is unaffected by general anesthesia [18].…”

Section: Discussionmentioning

confidence: 99%

“…In conscious individuals, there is a significant increase in the mABP of the upper extremities after a change in posture from the supine position to the BCP [8] [9], while the cerebral tissue oxygen saturation (SctO 2 ), a noninvasive indicator of cerebral perfusion, is unaffected by postural change [9] [10]. Moving into an upright position activates the sympathetic nervous system, resulting in an increase in the systemic vascular resistance (SVR) and the systemic BP and a reduction in the cardiac output (CO) [11]. In contrast, the upper extremity mABP and SctO 2 values are significantly decreased when the position of an anesthetized patient is changed to the BCP [8] [9] [10] [12].…”

Section: Introductionmentioning

confidence: 99%

“…General anesthesia causes a blunting of the baroreceptor responses (leading to an attenuation of the increase in the SVR that is observed when a conscious individual rises from the supine position), while the BP at the level of the heart and the CO are reduced [11]. However, it is not clear how the cardiac function is af-Open Journal of Anesthesiology fected when the BP is increased to the level that is required to maintain cerebral perfusion pressure in anesthetized patients in the BCP.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The Cardiac Function in the Beach Chair Position under General Anesthesia

Tanabe¹,

Yamada²,

Nagase³

et al. 2018

OJAnes

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Background: Shoulder surgery is performed in the beach chair position (BCP). The systemic arterial blood pressure (BP) must be increased to prevent cerebral hypoperfusion. However, it is not clear how the cardiac function is affected when BP increase to maintain cerebral perfusion pressure in anesthetized patients. Methods: An analysis was performed using the data from 13 patients. We prepared a parallel circuit using a FloTrac Sensor transducer and an arterial BP transducer. Following the transfer of the patient to the BCP under general anesthesia, the FloTrac Sensor transducer was placed at the level of the fourth intercostal space, the arterial BP transducer was placed at the external auditory meatus level. We selected two points before surgery (120 s apart), during which the mean arterial BP (mABP) at the level of the brain was stable and at which the values in the supine position and the BCP were within 5 mmHg. Results: While the patients were in the supine position, the mean mABP at the mid-axillary level was 65.7 mmHg. In the BCP, the mean mABP was 66.5 mmHg at the external auditory meatus and 80.7 mmHg at the fourth intercostal space. The cardiac index changed from 2.2 (supine position) to 2.5 l/min/m 2 (BCP). The stroke volume index was significantly increased from 35.8 to 42.3 ml/m 2 (P = 0.003). The heart rate changed from 63.0 to 58.6 beats/min. The stroke volume variation was significantly decreased from 12.4% to 8.8% (P = 0.024). Conclusion: In order to ensure patient safety, close attention should be paid to the systemic cardiovascular changes that occur when the BP is increased.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Cardiac Function in the Beach Chair Position under General Anesthesia

Tanabe¹,

Yamada²,

Nagase³

et al. 2018

OJAnes

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show abstract

“…2 In hypertensive patients, the lower limit of autoregulation might be shifted to the right. 3 The impact of extracranial contamination on cerebral oxygenation values indeed depends on the technology employed. However, changes in jugular venous bulb oxygenation 4 and middle cerebral artery blood velocity 5 were reported in patients in the upright position, suggesting a large intracranial contribution to the measured value.…”

Section: To the Editormentioning

confidence: 99%

In reply: Management of blood pressure alters cerebral oxygen saturation values in the beach chair position

Meex

Deyne

Jans

2016

Can J Anesth/J Can Anesth

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“…Many studies do show a reduction in this surrogate outcome, but the risks remain speculative due to lack of a large study reporting on neurological outcome. 42,43 Postoperative atrial fibrillation Further evidence of a predominantly embolic mechanism of postoperative strokes is found in the strong association between postoperative atrial fibrillation and stroke. 7,44,45 In turn, intraoperative hypotension is a risk factor for the development of atrial fibrillation.…”

Section: Congenital Variation Of the Circle Of Willismentioning

confidence: 99%