Neer Award 2012: Cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation

Cerebral tissue oxygen saturation values in volunteers and patients in the lateral decubitus and beach chair positions: a prospective observational study

“…19 With 57% of our patients under general anesthesia revealing SctO 2 values \ 55% and a decrease of C 20% from baseline in the BCP, we confirm previous results on the frequent occurrence of cerebral tissue oxygen desaturation in patients undergoing arthroscopic shoulder surgery in the BCP. [6][7][8][9][10][11] The combination of general anesthesia and controlled hypotension resulted in a median decrease in blood pressure of 45 mmHg in both of our patient groups. Brachial noninvasive blood pressure monitoring, as in our Volunteers were serially moved from the supine position to the beach chair position, followed by a return to the supine position and a final change to the lateral decubitus position.…”

“…Not surprisingly, several groups have reported their experience on the use of cerebral oximetry during shoulder surgery in the BCP, and every group revealed significant decreases in SctO 2 during the procedure. [6][7][8][9][10][11][12][13] Nevertheless, many questions remain about what constitutes a ''normal'' SctO 2 value and what SctO 2 values are acceptable during general anesthesia.…”

Randomized Trial of the Use of Dexmedetomidine vs. Propofol after Regional Blockade in Shoulder Surgery Patients in Beach Chair Position

“…A number of researchers have sought to characterize how hemodynamic variation can result in adverse cerebrovascular events [5] [6], especially while in beach chair position; however, no definitive study using EEG or cerebral oximetry has been reported to date [7]- [9]. As a result we propose the use of dexmedetomidine in conjunction with regional blockade in sitting position as a viable anesthetic option, especially in patients with difficult airway presenting for shoulder surgery.…”

Basic Shoulder Arthroscopy: Lateral Decubitus Patient Positioning

“…1,13,24 The final disadvantage that corresponds with the lateral decubitus position is that it will typically require general anesthesia because regional anesthesia is not well tolerated. 20,25 See Table 3 for a list of advantages and disadvantages of using the lateral decubitus position for shoulder arthroscopy.…”