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

Triplet, Jacob J.; Lonetta, Christopher M.; Levy, Jonathan C.; Everding, Nathan G.; Moor, Molly

doi:10.1016/j.jse.2014.06.041

Cited by 12 publications

(11 citation statements)

References 25 publications

(29 reference statements)

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“…The use of cerebral oximetry using near-infrared spectroscopy (NIRS) to monitor the adequacy of cerebral perfusion and to guide intraoperative interventions in shoulder surgery has become more common over the last decade. 1,3,4,91011121314151617181920212223242526272829303132…”

Section: Proposed Pathoanatomymentioning

confidence: 99%

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

et al. 2019

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The beach chair position (BCP) is commonly used position in upper extremity surgery. Although there are many advantages to surgery in this position, there are also potential drawbacks and described complications including devastating neurologic outcomes. The etiology of these complications is postulated to be due to the gravitational effects of the seated position leading to cerebral hypoperfusion. We review the current literature on intraoperative cerebral monitoring and neurocognitive complications with shoulder surgery performed in the BCP. A previous systematic review estimated the incidence of neurocognitive complications after surgery in the BCP to be 0.004%. However, the true incidence is unknown and is likely much more common. Reports of neurologic complications have revealed a need for heightened vigilance, alternative anesthesia techniques, and improved monitoring. Methods for monitoring have included near-infrared spectroscopy, a measurement of cerebral oximetry shown to reliably detect cerebral hypoperfusion. In this literature review, we sought to update the incidence of intraoperative cerebral desaturation events (CDEs) to investigate the relationship of CDEs to neurocognitive complications and to review recent reported cases of neurocognitive complications. Existing literature suggest that accurate intraoperative monitoring of cerebral perfusion may improve patient safety.

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Section: Proposed Pathoanatomymentioning

confidence: 99%

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

et al. 2019

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“…It has recently been suggested that to estimate appropriate cerebral perfusion blood pressure per se is less important than CO. Previous studies also observed an inconsistency between hypotension and CDEs occurrence [ 4 , 20 ]. Triplet et al [ 20 ] demonstrated that neither NIBP nor mean arterial pressure measured at the level of the temporal bone correlated with decreases in rSO 2 in the BCP.…”

Section: Discussionmentioning

confidence: 92%

“…Previous studies also observed an inconsistency between hypotension and CDEs occurrence [ 4 , 20 ]. Triplet et al [ 20 ] demonstrated that neither NIBP nor mean arterial pressure measured at the level of the temporal bone correlated with decreases in rSO 2 in the BCP. In another study comparing the BCP and a lateral position, there was no difference in mean arterial pressure despite a much higher incidence of CDEs [ 4 ].…”

Section: Discussionmentioning

confidence: 92%

“…For estimating CPP in the BCP, invasive arterial monitoring, with the transducer zeroed at the external auditory meatus, has been used commonly. Triplet et al [ 20 ] described that the eABP to NIBP ratio, measured at the level of the upper arm, declined as the tilting angle increased and concluded that eABP could be helpful as a surrogate for CPP. In this study, we defined hypotension as mean blood pressure < 65 mmHg or 20% or more higher than baseline and the measurement of eABP, but not NIBP, detected a significantly different incidence of hypotension between the groups.…”

Section: Discussionmentioning

confidence: 99%

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Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial

Woo

Kim

Jeong

et al. 2018

Korean J Anesthesiol

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BackgroundThe beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO2) in the BCP.MethodsPatients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO2 were recorded.ResultsData were analyzed from 19 patients per group. In the BCP, the values of rSO2 and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO2 and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO2 and blood pressure.ConclusionsThigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.

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“…The best way to determine adequacy of organ perfusion is debated. Mean arterial pressure (MAP) is often advocated, but cardiac index (CI) may be a better predictor of perfusion [8,18,24,25]. For example, phenylephrine increases blood pressure but decreases cardiac output and regional cerebral oxygen saturation (SctO 2 ) [12].…”

Section: Introductionmentioning

confidence: 99%

Cerebral Oxygenation in the Sitting Position is Not Compromised During Spontaneous or Positive-Pressure Ventilation

YaDeau

Kahn

Lin

et al. 2019

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: General anesthesia with neuromuscular blockade may facilitate total shoulder arthroplasty but appears to increase risk of cerebral oxygen desaturation. Cerebral desaturation is undesirable and is a proxy for risk of stroke. Purposes/Questions: This study tested the hypothesis that cerebral oxygen desaturation occurs frequently during general anesthesia with neuromuscular blockade and positivepressure ventilation but does not occur with spontaneous ventilation. Correlations were sought among cerebral oxygen saturation, blood pressure, and cardiac index. Methods: We designed a prospective, observational, cohort study to measure cerebral oxygenation in 25 patients during general anesthesia, both with and without positive-pressure ventilation. Patients undergoing elective shoulder arthroplasty in the sitting position received an arterial catheter, near-infrared spectroscopic measurement of cerebral oxygenation, and non-invasive cardiac output measurement. Moderate hypotension was allowed. Blood pressure was supported as needed with ephedrine or low-dose epinephrine (but avoiding phenylephrine). Hypercapnia (45 to 55 mmHg) was targeted during positive-pressure ventilation. Results: No cerebral oxygen desaturations occurred, regardless of ventilation mode. Under positive-pressure ventilation, the median (interquartile range: Q1, Q3) cerebral oxygenation was 110% of baseline (104, 113), the mean arterial pressure was 62% of baseline (59, 69), and the cardiac index was 82% of baseline (71, 104). Cerebral oxygenation did not correlate with blood pressure or cardiac index but had moderate correlation with end-tidal carbon dioxide. No strokes occurred. Conclusions: There were no signs of inadequate brain perfusion during general anesthesia using paralytic agents. Positive-pressure ventilation with moderate hypotension in the sitting position does not endanger patients, in the context of moderate hypercapnia and hemodynamic support using ephedrine or epinephrine.

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

Cited by 12 publications

References 25 publications

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial

Cerebral Oxygenation in the Sitting Position is Not Compromised During Spontaneous or Positive-Pressure Ventilation

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