Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables

Abstract

Since hypotension in beach chair position (BCP) can lead to catastrophic neurologic complications, the prediction of hypotension is a matter of concern in the BCP under general anesthesia. We investigated whether pre-induction values of mean arterial pressure (MAP), stroke volume variation (SVV), cardiac index (CI), and stroke volume index (SVI) can predict hypotension in BCP during general anesthesia. Forty healthy adult patients, aged 18-65 years, undergoing elective arthroscopic shoulder surgery, were enrolled. At 5 min after anesthesia induction, patients were placed in the 70° upright position. Receiver operating characteristic (ROC) curves were plotted for preoperative hemodynamic variables, including MAP, SVV, CI and SVI, and their abilities to predict hypotension were investigated. Fifteen patients developed hypotension after being moved from the supine to the BCP. The areas under the ROC curves for pre-induction values of MAP, CI, and SVI and post-induction value of SVV before a positional change were 0.556 (95% CI 0.373-0.739; p = 0.557), 0.735 (0.576-0.894; p = 0.014), 0.787 (0.647-0.926; p = 0.003), and 0.691 (0.525-0.857; p = 0.046), respectively. In this study, pre-induction values of CI and SVI and post-induction value of SVV before a positional change predicted hypotension in the BCP under general anesthesia. Our findings suggest that not only preload but also preoperative cardiac performances might be the important factors for the development of hypotension after a repositioning supine to the sitting during general anesthesia.

Inferior vena cava diameter as a predicting factor for hypotension after induction of general anesthesia in elderly patients

“…Sufentanil lowers HR mainly through vagal nerve stimulation via the central nervous system, while propofol does not have prominent effects on HR 3,17 . Cisatracurium besilate at clinical doses has little effect on the cardiovascular system 18 There are many methods used to predict post-IGA hypotension, including cardiac index, stroke volume index, post-induction stroke volume variation, HR variability [19][20] , and perfusion variation index 1 . The IVC ci can reportedly predict the occurrence of post-IGA hypotension in a relatively accurate way 13 .…”

Year in review in journal of clinical monitoring and computing 2014: cardiovascular and hemodynamic monitoring

“…In the April issue, Yi Jo and colleagues investigated the big issue of hypotension associated with the beach chair position (BCP) during general anesthesia in forty healthy adult patients undergoing elective arthroscopic shoulder surgery [1]. Indeed, although fluid preloading with crystalloid or colloid fluids may alleviate the hemodynamic consequences associated with the BCP during general anesthesia, the present fluid therapy may possibly lead to volume overload.…”

“…Indeed, although fluid preloading with crystalloid or colloid fluids may alleviate the hemodynamic consequences associated with the BCP during general anesthesia, the present fluid therapy may possibly lead to volume overload. In this regard, the authors investigated whether hemodynamic variables obtained using the FloTrac/Vigileo system, including mean arterial pressure and stroke volume variations (SVV) could predict hypotension in mechanically ventilated patients undergoing BCP [1]. Hypotension related to the BCP posture occurred in 37.5 % of patients in this study and the authors found that in contrast to post-induction value of SVV in mechanically ventilated state, pre-induction SVV cannot predict hypotension associated with the BCP in this study [1].…”

“…In this regard, the authors investigated whether hemodynamic variables obtained using the FloTrac/Vigileo system, including mean arterial pressure and stroke volume variations (SVV) could predict hypotension in mechanically ventilated patients undergoing BCP [1]. Hypotension related to the BCP posture occurred in 37.5 % of patients in this study and the authors found that in contrast to post-induction value of SVV in mechanically ventilated state, pre-induction SVV cannot predict hypotension associated with the BCP in this study [1]. These results are related to the fact that dynamic indices are wellknown to predict fluid responsiveness only in controlled mechanically ventilated patients as they strongly depend on respiratory status.…”

Die fokussierte transthorakale Echokardiografie in der perioperativen Versorgung

“…Um auch bei dieser Lagerung eine ausreichende Perfusion des Gehirns zu gewährleisten, bedarf es einer engmaschigen Kontrolle des Blutdrucks. Bei Risikopatienten wird die Indikation zur Etablierung einer invasiven Blutdruckmessung mit erweitertem hämodynamischem Monitoring daher meist großzügiger gestellt[27]. Abb.…”