Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome

Aguirre, José; Märzendorfer, Olivia; Brada, Muriel; Saporito, Andrea; Borgeat, Alain; Bühler, Philipp

doi:10.1016/j.jclinane.2016.08.035

Cited by 25 publications

(16 citation statements)

References 43 publications

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“…The average operation time in our case series was 52 min, making the operation time itself rather short. The benefits associated with short operations are: reduction of infection rates, shorter time in the "beach chair" position, a shorter duration of anesthesia, and finally an economic benefit [13]. What should be noted in particular, however, is the fact that accompanying pathologies can be addressed straight away, and thus the surgical technique sets itself apart from isolated fixed-angle plate osteosyntheses.…”

Section: Discussionmentioning

confidence: 99%

3-Year results of arthroscopic management of lateral clavicle fractures

et al. 2020

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Section: Discussionmentioning

confidence: 99%

3-Year results of arthroscopic management of lateral clavicle fractures

et al. 2020

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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%

“…NIRS is a measurement of cerebral oximetry that has been shown to strongly correlate with middle cerebral artery flow velocity and to reliably detect cerebral hypoperfusion. 9 NIRS is noninvasive and readily available at most hospitals, as this technology is often used intraoperatively for procedures with a high risk of neurologic complications including cardiac, intra-abdominal, neurologic, and vascular surgeries. 3,40 Twenty recent publications have reported on intraoperative perfusion monitoring of patients undergoing shoulder arthroscopy in the BCP.…”

Section: Intraoperative Cerebral Perfusion Monitoringmentioning

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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“…Monitoring devices like NIRS are routinely used during cardiopulmonary bypass 11 and at times for surgery in the beach chair position (=BCP, sitting upright) 12 . This position is well‐known to physiologically challenge cerebral blood flow regulation in conjunction with general anaesthesia 13 . However, clinical trials have yet to consistently demonstrate perioperative stroke risk‐reduction from these technologies 7 …”

Section: Introductionmentioning

confidence: 99%

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

Larsen

Kobborg

Shahim

et al. 2020

Acta Anaesthesiol Scand

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Background Cerebral hypoxia may occur during surgery but currently used cerebral oxygenation saturation (rSO2) monitors remain controversial with respect to improving clinical outcome. Novel neuroprotein biomarkers are potentially released into systemic circulation and combined with near‐infrared spectroscopy (NIRS) could clarify the presence of per‐operative cerebral hypoxia. We investigated changes to serum‐neuroprotein concentrations post‐surgically, paired with NIRS and cognitive outcome, in patients operated in the beach chair position (BCP). Methods A prospective cohort in 28 shoulder surgery patients placed in the BCP. Blood samples were collected before induction of anaesthesia, and 2 hours and 3‐5 days post‐operatively. We analysed blood levels of biomarkers including tau and neurofilament light (NFL). We post hoc assessed the cross‐wise relationship between biomarker levels and post‐surgical changes in cognitive function and intraoperatively monitored rSO2 from NIRS. Results Serum‐NFL decreased from 24.2 pg/mL to 21.5 (P = .02) 2 hours post‐operatively, then increased to 27.7 pg/mL on day 3‐5 (P = .03). Conversely, s‐tau increased from 0.77 pg/mL to 0.98 (2 h), then decreased to 0.81 on day 3‐5 (P = .08). In 14/28 patients, episodic rSO2 below 55% occurred, and the duration < 55% was correlated to change in s‐tau (P < .05). The cognitive function z‐score at 1 week and 3 mo. correlated to the change in tau (P = .01), but not to NFL. Conclusion Some biomarkers were significantly changed with surgery in the beach chair position. The change was at some points associated to post‐operative cognitive decline, and to intraoperative low rSO2. (237).

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Cerebral oxygenation in the beach chair position for shoulder surgery in regional anesthesia: impact on cerebral blood flow and neurobehavioral outcome

Cited by 25 publications

References 43 publications

3-Year results of arthroscopic management of lateral clavicle fractures

3-Year results of arthroscopic management of lateral clavicle fractures

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Serum‐neuroproteins, near‐infrared spectroscopy, and cognitive outcome after beach‐chair shoulder surgery: Observational cohort study analyses

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