Cerebral Oxygen Desaturation Events Assessed by Near-Infrared Spectroscopy During Shoulder Arthroscopy in the Beach Chair and Lateral Decubitus Positions

Abstract

Shoulder surgery in the BCP is associated with significant reductions in cerebral oxygenation compared with values obtained in the LDP.

Extracranial contamination in the INVOS 5100C versus the FORE-SIGHT ELITE cerebral oximeter: a prospective observational crossover study in volunteers

“…As brain oxygen demand remains relatively stable under anesthesia, changes in SctO 2 typically represent reductions in cerebral oxygen supply, which are often due to reductions in blood pressure, carbon dioxide partial pressure, cardiac output, hemoglobin concentration, and/or arterial oxygen content. [5][6][7][8][9][10][11][12] The accuracy of SctO 2 measurements under a variety of clinical conditions is essential if appropriate assessment and management of brain oxygenation is to be possible. Nevertheless, previous studies suggest that extracranial contamination can influence the measurement of SctO 2 and result in measured values that do not entirely reflect the status of oxygenation in the brain.…”

“…[1][2][3][4][5][6] The INVOS 5100C used in this study uses two wavelengths of infrared light (730 and 810 nm) and two light detectors at two different fixed distances (proximal and distal) from the light source. 1,[9][10][11][12] The secondgeneration FORE-SIGHT ELITE device used in this study uses an enhanced proprietary algorithm coupled with five wavelengths of infrared light (680, 730, 770, 805, and 870 nm) to improve the accuracy of the blood oxygenation measurements. 14 MacLeod et al examined the accuracy of the first-and second-generation FORE-SIGHT monitors in volunteers.…”

More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position

“…It has been shown that shoulder surgery patients in the beach chair position experience significant reductions in cerebral oxygen saturation as compared with patients in the lateral decubitus position. 3 Antihypertensive medications, including angiotensinconverting enzyme inhibitors (ACEI) and angiotensin receptor antagonists (ARA), can contribute to perioperative hypotension, particularly after induction of general anesthesia. [4][5][6] Preoperative administration of antihypertensive therapy leads to a greater incidence of hypotension in patients who undergo surgery in the supine position.…”

Avoid hypotension and hypoxia: an old anesthetic adage with renewed relevance from cerebral oximetry monitoring

“…Evidence from orthopedic patients under going shoulder surgery points to the utility of NIRS in detecting less severe but potentially prolonged hypotension and its effects on outcome. 7 Using cerebral tissue oxygen saturation as an indirect measure of relative CBF could facilitate outlining the autoregulatory relationship between blood pressure and CBF. Indeed, evidence linking the impairment in NIRS-derived autoregulation and adverse neurologic outcomes in cardiac surgery suggests the potential for real-time monitoring that may identify opportunities to alter outcome.…”

“…Des données probantes obtenues de patients subissant une chirurgie orthopédique de l'épaule indiquent l'utilité de la NIRS pour dépister les épisodes d'hypotension moins grave mais potentiellement prolongée ainsi que leurs effets sur les devenirs. 7 En se servant de la saturation en oxygène des tissus cérébraux comme mesure indirecte du DSC relatif, on pourrait déterminer la relation d'autorégulation entre la tension et le DSC. En effet, des données probantes associant une détérioration de l'autorégulation mesurée par la NIRS à des complications neurologiques après chirurgie cardiaque laissent supposer qu'un monitorage en temps réel a le potentiel de reconnaître les occasions de modifier le pronostic.…”