Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects

Salazar, Dane; Sears, Benjamin W.; Aghdasi, Bayan; Only, Arthur J.; Francois, Audrice; Tonino, Pietro; Marra, Guido

doi:10.1016/j.jse.2012.12.036

Cited by 62 publications

(40 citation statements)

References 33 publications

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“…19 With 57% of our patients under general anesthesia revealing SctO 2 values \ 55% and a decrease of C 20% from baseline in the BCP, we confirm previous results on the frequent occurrence of cerebral tissue oxygen desaturation in patients undergoing arthroscopic shoulder surgery in the BCP. [6][7][8][9][10][11] The combination of general anesthesia and controlled hypotension resulted in a median decrease in blood pressure of 45 mmHg in both of our patient groups. Brachial noninvasive blood pressure monitoring, as in our Volunteers were serially moved from the supine position to the beach chair position, followed by a return to the supine position and a final change to the lateral decubitus position.…”

Section: Discussionmentioning

confidence: 65%

“…Not surprisingly, several groups have reported their experience on the use of cerebral oximetry during shoulder surgery in the BCP, and every group revealed significant decreases in SctO 2 during the procedure. [6][7][8][9][10][11][12][13] Nevertheless, many questions remain about what constitutes a ''normal'' SctO 2 value and what SctO 2 values are acceptable during general anesthesia.…”

Section: Résumémentioning

confidence: 99%

See 1 more Smart Citation

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

Meex

Vundelinckx

Buyse

et al. 2016

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 65%

Section: Résumémentioning

confidence: 99%

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

Meex

Vundelinckx

Buyse

et al. 2016

Can J Anesth/J Can Anesth

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“…Thus, for this patient population, the severity and duration of desaturation that causes cerebral ischemia and the relationship with mean arterial blood pressure at the level of the brain remain undefined. The incidence of CDE in patients monitored with NIRS undergoing elective shoulder surgery in the beach chair position in the published literature is quite variable and ranges from 8% to 80% [5,7,17,23,29,34]. In our patient series, the incidence of CDE was 18% (nine of 51).…”

Section: Discussionmentioning

confidence: 69%

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Salazar

Sears

Andre

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia. Questions/purposes We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs. Methods Regional cerebral tissue oxygen saturation (rSO 2 ) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO 2 of 20% or greater were defined as CDEs. Results The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO 2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes). Conclusions The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…A number of studies, including case reports, observational studies and a randomized trial have used ScO 2 measurement to monitor cerebral oxygenation during beachchair surgery (Table 1) [29,125,[128][129][130][131][132][133][134][135]. These studies confirm that beachchair positioning is associated with hypotension and ScO 2 desaturation, ranging from 0 % to over 80 %.…”

Section: Monitoring Sco 2 In Beachchairmentioning

confidence: 94%

“…In these cases alternative surgical positioning should be sought or a regional technique with minimal sedation considered. Obesity, identified as a risk factor for cerebral desaturation [128] and patients with autonomic failure are more susceptible to postural hypotension [91]. During awake tilttesting patients with autonomic dysfunction exhibit a critical reduction in cerebral oxygen delivery and ScO 2 [143].…”

Section: Clinical Recommendations For Upright Positioningmentioning

confidence: 99%

Effects of Positioning on Cerebral Oxygenation

Soeding

2013

Curr Anesthesiol Rep

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Postural change during anesthesia has a complex effect on the systemic and cerebral circulations which can potentially decrease cerebral blood flow and oxygenation. Cerebral oximetry is emerging as a monitor of cerebral perfusion with widespread application in many types of surgery. The technology is based on the differential absorption of oxygenated and deoxygenated hemoglobin to near-infrared light. However, the dynamic coupling that exists between cerebral arterial, venous and cerebrospinal fluid volumes may influence oximetric readings during postural change. Interpretation of cerebral oxygen saturation measurement must account for these changes in cerebral physiology if monitoring is to predict neurological outcome.

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Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects

Cited by 62 publications

References 33 publications

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Effects of Positioning on Cerebral Oxygenation

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