Risk factors associated with hypotensive bradycardic events during open shoulder surgery in the beach chair position

Abstract

Background: Shoulder surgery in the beach chair position frequently causes hypotensive bradycardic events (HBEs), which are potentially associated with an increased risk of cerebral hypoperfusion. Here, we aimed to investigate the incidence and characteristics of symptomatic HBEs that require pharmacological interventions, and to identify specific risk factors associated with symptomatic HBEs. Methods: We retrospectively examined the records of all patients aged ≥ 18 years who underwent shoulder arthrotomy in the beach chair position between January 2011 and December 2018 at a tertiary hospital. For patients who experienced HBEs while in the beach chair position, the minimum heart rate and systolic blood pressure were noted, as was the total dose of ephedrine or atropine. Results: Symptomatic HBEs occurred in 61.0% of all cases (256/420). Two patients with symptomatic HBEs experienced postoperative neurological complications. Multivariable logistic regression analysis showed that preoperative interscalene brachial plexus block (ISB) and advanced age were risk factors associated with symptomatic HBEs

Retrospective analysis of risk factors of hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene blockade in the sitting position

“…Our results may suggest that HBEs cannot be separated from various other types of syncopal reaction. However, preoperative ISB was reported as one of the risk factors associated with HBEs in a recent study of open shoulder surgery [ 23 ]. Further studies are thus needed before a definite conclusion can be drawn about the impact of the ISB on HBEs.…”

Recent advances and future trends in shoulder arthroscopy

“…[38] In another study, pre-operative interscalene brachial plexus (BP) block and advanced age were risk factors associated with symptomatic hypotensive bradycardic events in the beach chair position. [39] The beach chair position angle was shown to affect cerebral oxygenation, and there was a linear decline in cerebral oxygenation as the position angle increased. [40] The current recommendations suggest that beach chair and lateral position are safe and successful methods for patient positioning in shoulder arthroscopic procedures without conclusive evidence of superiority of one position to the other.…”

Emerging safety concerns in elderly patients undergoing shoulder surgery

“…In particular, there is the possibility of a serious side effects of compromised cerebral perfusion in the beach chair position by which improves intra-articular visualization during arthroscopic surgery. Choi et al [6] showed that symptomatic hypotensive bradycardia occurred in 60% of all shoulder surgeries with the beach chair position and that preoperative interscalene brachial plexus block and old age were risk factors for symptomatic hypotensive bradycardia. During shoulder arthroscopy, hypothermia is common and can be contributed by the irrigation of the shoulder joint, impaired thermoregulation, and vasodilation due to anesthesia.…”

“…Lee et al [8] found that perioperative hypothermia was more prevalent in general anesthesia than in interscalene brachial plexus block combined with propofol sedation. They also showed that there was no difference in the incidence of hypothermia between the elderly and younger patient groups.From these retrospective studies [4,6,8], it is thought that elderly patients with comorbidities are unlikely to be discharged on the same day and are at an increased risk of readmission in the setting of ambulatory shoulder surgery. Old age may also be associated with a high risk of hypotensive bradycardia, particularly in the beach chair position.…”

“…From these retrospective studies [4,6,8], it is thought that elderly patients with comorbidities are unlikely to be discharged on the same day and are at an increased risk of readmission in the setting of ambulatory shoulder surgery. Old age may also be associated with a high risk of hypotensive bradycardia, particularly in the beach chair position.…”