Effect of blood pressure elevation on cerebral oxygen desaturation in the beach chair position

Hayashi, Keishu; Tanabe, Kumiko; Minami, Kimito; Sakata, Koji; Nagase, Kenji; Iida, Hiroki

doi:10.1016/j.aja.2017.05.007

Cited by 11 publications

(11 citation statements)

References 12 publications

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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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“…The calculation of sample size was based on previous studies reporting that forehead rSO2 increased by a mean of 3% (standard deviation [SD] = 7%) or decreased by a mean of 4% (SD = 7%) after shifting from the supine position to RALP [9,10,14] or BCP to maintained anesthesia using intravenous anesthetics or inhalation anesthetics [8,12,16]. For a power of 0.8 and a P-value of 0.05, a sample size of 65 patients was calculated to enable the detection of a clinically relevant change in rSO2.…”

Section: Discussionmentioning

confidence: 99%

Forehead Regional Oxygen Saturation (rSO2)-Related Ear-Level Arterial Pressure and Lower Thigh rSO2 in the Steep Trendelenburg Position with CO2 Pneumoperitoneum and the Beach Chair Position

Fukada

Tsuchiya

Iwakiri

et al. 2021

Cureus

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IntroductionRegional oxygen saturation (rSO2) reflects tissue perfusion. This observational study aimed to examine the change in the forehead and lower thigh rSO2 associated with intraoperative posture, anesthesia regimen, or mean arterial pressure (mAP) at heart and external auditory meatus (ear) levels. MethodsPatients undergoing robot-assisted laparoscopic radical prostatectomy in the Trendelenburg position at 30°w ith pneumoperitoneum (TPP) or arthroscopic shoulder surgery in the beach chair position at 70° (BCP) under desflurane-remifentanil (D/R) or propofol-remifentanil (P/R) anesthesia were examined. Bilateral forehead and lower thigh rSO2 values and mean radial artery pressure were measured simultaneously at heart and ear levels. ResultsIn TPP, there were no differences under anesthesia regimens in the forehead or lower thigh rSO2 change, although one patient with an absolute lower thigh rSO2 of ≤50% in the lithotomy position complained of transient limb pain. No correlation was observed between rSO2 and mAP. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased under either of the anesthesia regimens. The coefficient of correlation between forehead rSO2 and heart-level and ear-level mAP was 0.341 and 0.236, respectively. ConclusionsThere were no differences under anesthesia regimens in the changes of forehead rSO2 and lower thigh rSO2. In TPP, significant changes in forehead rSO2 and lower thigh rSO2 were not observed. Monitoring lower thigh rSO2 might be useful for preventing lower extremity pain. In BCP, forehead rSO2 decreased and lower thigh rSO2 increased from the supine position to the BCP. To prevent brain damage, anesthesiologists should pay attention to heart-and ear-level mAP.

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“…Therefore, the ABP transducer should be placed at the level of the external auditory meatus and not at the level of the heart upon insertion of an invasive percutaneous arterial catheter. [ 2 , 8 ] Further studies should be required for the clinical correlation between MAP at external meatus and rSO2. A second reason is that patients with hypertension or diabetes mellitus were included in this study.…”

Section: Discussionmentioning

confidence: 99%

“…The pressure transducer was placed at the level of external auditory meatus. [ 8 ] Mean arterial pressure (MAP), stroke volume variance (SVV), and cardiac index (CI) were measured using a Vigileo/Flotrac system (Edward Lifesciences, Irvine, CA). We calculated the total systemic vascular resistance index (TSVRi).…”

Section: Methodsmentioning

confidence: 99%

Effect of phenylephrine infusion on hypotension induced by the beach chair position

Ko¹,

Kim²,

Lee³

et al. 2020

Medicine

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Background: The beach chair position (BCP), used during shoulder surgery, is associated with hypotension, bradycardia, and risk of cerebral hypoperfusion. Phenylephrine is commonly used as a first treatment of choice of intraoperative hypotension during surgery. We evaluated the hemodynamic effects of 2 doses of intravenous phenylephrine infusion administered before being placed in BCP for arthroscopic shoulder surgery. The primary endpoint was the incidence of hypotension after positional change. Methods: Sixty-six patients were randomized to receive either intravenous normal saline (group NS) or intravenous phenylephrine infusion (0.5 μg/kg/min, group LP or 1.0 μg/kg/min, group HP) for 5 minutes before being placed in the BCP. Mean arterial pressure(MAP), heart rate, stroke volume variation, and cardiac index were measured before and after positional change. Results: The total incidence of hypotension after the BCP was 93.65%, but was not significantly different among the 3 groups. However, there was a significant difference in trends between the groups for MAP for 5 minutes after BCP ( P = .028). Comparison of changes in MAP at 1 minute compared to post-induction MAP was significantly different between group HP and group NS ( P = .014). Conclusion: Infusion of 0.5 and 1.0 μg/kg/min of phenylephrine for 5 minutes before the BCP has no preventive effect for incidence of hypotension. However, this study showed that 1.0 μg/kg/min of phenylephrine infusion for 5 minutes can attenuate the severity of hypotension.

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Effect of blood pressure elevation on cerebral oxygen desaturation in the beach chair position

Cited by 11 publications

References 12 publications

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Cerebral Desaturation Events During Shoulder Arthroscopy in the Beach Chair Position

Forehead Regional Oxygen Saturation (rSO2)-Related Ear-Level Arterial Pressure and Lower Thigh rSO2 in the Steep Trendelenburg Position with CO2 Pneumoperitoneum and the Beach Chair Position

Effect of phenylephrine infusion on hypotension induced by the beach chair position

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