Effects of Beach-Chair Position and Induced Hypotension on Cerebral Oxygen Saturation in Patients Undergoing Arthroscopic Shoulder Surgery

Lee, Jae H.; Min, Kyungha; Chun, Yong-Min; Kim, E. J.; Choi, Sun‐Woo

doi:10.1016/j.arthro.2011.02.027

Cited by 69 publications

(34 citation statements)

References 20 publications

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“…There are some reports about stroke, loss of vision, and ophthalmoplegia, which are possibly related to hypotension, reduction of blood flow of the vertebral artery due to hyperextension and rotation or tilt of the head, which could decrease cerebral oxygenation resulting in cerebral ischemia (11,12). However, these reports have not been confirmed by other studies, Lee et al showed that unlike the pattern of MAP values, there was no additional decrease in rSO2 in seated position during anesthesia (13).…”

Section: Introductioncontrasting

confidence: 49%

Cerebral Oxygen Monitoring: An Observational Prospective Study on Seated Position Neurosurgical Procedures

et al. 2017

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Section: Introductioncontrasting

confidence: 49%

Cerebral Oxygen Monitoring: An Observational Prospective Study on Seated Position Neurosurgical Procedures

et al. 2017

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“…There is a high incidence of hypotension in this position, which is the cause for some concern due to the risk of insufficient cerebral perfusion [1-3]. …”

Section: Introductionmentioning

confidence: 99%

“…Blood pressure decreases during general anaesthesia as a result of several factors [6]. The average blood pressure reduction seen under interscalene block is generally less pronounced, but there are sudden episodes of severe hypotension with bradycardia caused by the Bezold-Jarisch reflex [1,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy

Janssen

Stosch²,

Pöschl³

et al. 2014

BMC Anesthesiol

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BackgroundShoulder surgery is often performed in the beach-chair position, a position associated with arterial hypotension and subsequent risk of cerebral ischaemia. It can be performed under general anaesthesia or with an interscalene brachial plexus block, each of which has specific advantages but also specific negative effects on blood pressure control. It would be worthwhile to combine the advantages of the two, but the effects of the combination on the circulation are not well investigated. We studied blood pressure, heart rate, and incidence of adverse circulatory events in patients undergoing shoulder surgery in general anaesthesia with or without an interscalene block.MethodsProspective, randomised, blinded study in outpatients (age 18 to 80 years) undergoing shoulder arthroscopy. General anaesthesia was with propofol/opioid, interscalene block with 40 ml 1% mepivacaine. Hypotension requiring treatment was defined as a mean arterial pressure <60 mmHg or a systolic pressure <80% of baseline; relevant bradycardia was a heart rate <50 bpm with a decrease in blood pressure.ResultsForty-two patients had general anaesthesia alone, 41 had general anaesthesia plus interscalene block. The average systolic blood pressure under anaesthesia in the beach-chair position was 114 ± 7.3 vs. 116 ± 8.3 mmHg (p = 0.09; all comparisons General vs. General-Regional). The incidence of a mean arterial pressure under 60 mmHg or a decrease in systolic pressure of more than 20% from baseline was 64% vs. 76% (p = 0.45). The number of patients with a heart rate lower than 50 and a concomitant blood pressure decrease was 8 vs. 5 (p = 0.30).ConclusionOne can safely combine interscalene block with general anaesthesia for surgery in the beach-chair position in ASA I and II patients.Clinical trial numberDRKS00005295.

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“…Importantly, CBF decreased by 22% as the MAP declined, suggesting that autoregulation was impaired. Similarly, Lee et al evaluated cerebral perfusion in 27 patients under GA with PPV, during BCP with induced hypotension 44. MAP, measured at the level of ear, was maintained above 60 mm Hg.…”

Section: Discussionmentioning

confidence: 99%

Daring discourse: is nerve block with sedation the safest anesthetic for beach chair position?

Orebaugh

Palmeri

Lin

et al. 2019

Reg Anesth Pain Med

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Effects of Beach-Chair Position and Induced Hypotension on Cerebral Oxygen Saturation in Patients Undergoing Arthroscopic Shoulder Surgery

Cited by 69 publications

References 20 publications

Cerebral Oxygen Monitoring: An Observational Prospective Study on Seated Position Neurosurgical Procedures

Cerebral Oxygen Monitoring: An Observational Prospective Study on Seated Position Neurosurgical Procedures

Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy

Daring discourse: is nerve block with sedation the safest anesthetic for beach chair position?

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