The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position: a randomized blinded study

Cox, Ryan M.; Jamgochian, Grant; Nicholson, Kristen; Wong, Justin C.; Namdari, Surena; Abboud, Joseph A.

doi:10.1016/j.jse.2017.11.004

Cited by 21 publications

(31 citation statements)

References 22 publications

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“…Our meta-analysis of HR-responses over time considered two sub-groups based on the type of anaesthesia and maintenance agents used. BL-HR was reported in 48 SGs ( n = 1334); 12 used TIVA-propofol[ 16 33 34 35 36 37 ] (73.7 ± 13.4 beats/min, n = 451), 33 received inhaled anaesthetics[ 16 29 35 38 39 40 41 42 43 44 45 46 47 48 49 50 ] (73.6 ± 13.6 beats/min, n = 744) and 139 subjects had ISB. [ 6 50 ] MDs between HR-values at supine (Pre-BCP) and post-BCP status are depicted in Figure 4 .…”

Section: Resultsmentioning

confidence: 99%

“…Sensitivity analysis revealed that various anaesthetic agents significantly influenced fall in HRs. However, it made little difference to the overall results when study controls[ 29 30 33 34 35 37 39 40 41 42 43 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 ] and randomised trials[ 4 6 12 13 15 16 26 27 28 29 30 33 34 35 37 38 39 41 42 44 45 46 47 50 55 60 61 64 ] were analysed separately [ Table 2 ]. Meta-regression was performed since primary outcomes, characterised by significant heterogeneity, yielded statistically significant omnibus P values for statistical models considering different maintenance agents and opioids.…”

Section: Resultsmentioning

confidence: 99%

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Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

et al. 2020

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Background and Aims: Evaluations of adverse heart rate (HR)-responses and HR-variations during anaesthesia in beach-chair-position (BCP) for shoulder surgeries have not been done earlier. We analysed the incidence, associations, and interpretations of adverse HR-responses in this clinical setting. Methods: We performed a meta-analysis of trials that reported HR-related data in anaesthetised subjects undergoing elective shoulder surgeries in BCP. Studies included prospective, randomised, quasi-randomised and non-randomised, controlled clinical trials as well as observational cohorts. Literature search was conducted in MEDLINE, EMBASE, CINHAL and the Cochrane Central Register of Controlled Trials of the 21 st century. In the first analysis, we studied the incidence and associations of bradycardia/hypotension-bradycardia episodes (HBE) with respect to the type of anaesthesia and different pharmacological agents. In the second, we evaluated anaesthetic influences, associations and inter-relationships between monitored parameters with respect to HR-behaviours. Results: Among the trials designed with bradycardia/HBE as a primary end point, the observed incidence of bradycardia was 9.1% and that of HBE, 14.9% and 22.7% [(for Interscalene block (ISB) ± sedation) subjects and general anaesthesia (GA) + ISB, respectively]. There was evidence of higher observed risk of developing adverse HR-responses for GA subjects over ISB (Risk Difference, P < 0.05). Concomitant use of β-agonists did not increase risk of HBEs ( P = 0.29, I 2 = 11.4%) or with fentanyl ( P = 0.45, I 2 = 0%) for ISB subjects (subgroup analysis). Fentanyl significantly influenced the HR-drop over time [meta-regression, estimates (standard error), 14.9 (5.4), 9.8 (4.3) and 17 (2.6); P = 0.007, 0.024 and <0.001; for early, mid and delayed periods, respectively] in GA subjects. With respect to number of subjects experiencing cerebral desaturation events (CDEs), total intravenous anaesthesia (TIVA)- propofol had higher risk over inhalational anaesthesia ( P = 0.006, I 2 = 86.7%). Meta-correlation analysis showed relationships between the HR and rSO 2 (regional cerebral oxygen saturation) or SjvO 2 (jugular venous oxygen saturation) values (r = 0.608, 95%CI, 0.439 to 0.735, P < 0.001, I 2 = 77.4% and r = 0.397, 95%CI, 0.151 to 0.597, P < 0.001, I 2 = 64.3%, respectively). Conclusions: There is not enough evidence to claim the associations of adverse HR-responses with any specific factor. H...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

et al. 2020

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“…Intra‐operative controlled hypotension is not recommended as there is insufficient procedure‐specific evidence regarding its analgesic benefits. Moreover, there is a concern that hypotension may increase the risk of a reduction in cerebral perfusion and oxygenation .…”

Section: Discussionmentioning

confidence: 99%

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

et al. 2019

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Summary Rotator cuff repair can be associated with significant and difficult to treat postoperative pain. We aimed to evaluate the available literature and develop recommendations for optimal pain management after rotator cuff repair. A systematic review using procedure‐specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials published in English from 1 January 2006 to 15 April 2019 assessing postoperative pain after rotator cuff repair using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. Out of 322 eligible studies identified, 59 randomised controlled trials and one systematic review met the inclusion criteria. Pre‐operative and intra‐operative interventions that improved postoperative pain were paracetamol, cyclo‐oxygenase‐2 inhibitors, intravenous dexamethasone, regional analgesia techniques including interscalene block or suprascapular nerve block (with or without axillary nerve block) and arthroscopic surgical technique. Limited evidence was found for pre‐operative gabapentin, perineural adjuncts (opioids, glucocorticoids, or α‐2‐adrenoceptor agonists added to the local anaesthetic solution) or postoperative transcutaneous electrical nerve stimulation. Inconsistent evidence was found for subacromial/intra‐articular injection, and for surgical technique‐linked interventions, such as platelet‐rich plasma. No evidence was found for stellate ganglion block, cervical epidural block, specific postoperative rehabilitation protocols or postoperative compressive cryotherapy. The analgesic regimen for rotator cuff repair should include an arthroscopic approach, paracetamol, non‐steroidal anti‐inflammatory drugs, dexamethasone and a regional analgesic technique (either interscalene block or suprascapular nerve block with or without axillary nerve block), with opioids as rescue analgesics. Further randomised controlled trials are required to confirm the influence of the recommended analgesic regimen on postoperative pain relief.

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“…Although bSo 2 monitoring is routinely performed in many cardiac-surgery centers, it is not a universally standardized practice, and has recently been used in specific major noncardiac surgeries [9,29,31]. In orthopedic surgery, for instance, this technology has been exclusively used in patients undergoing shoulder surgery in the beach-chair position [32,59,60]. This could be a reason why there is insufficient evidence to support its use in this type of procedure.…”

Section: Discussionmentioning

confidence: 99%

“…After the search process, step-by-step results, which are presented graphically in the standard flowchart provided by the PRISMA group ( Figure 1) [27], a total of 12 RCTs were eligible [28][29][30][31][32][33][34][35][36][37][38][39]. They involved a total population of 1626 major surgery patients (cardiac and noncardiac surgical procedures).…”

Section: Study Characteristicsmentioning

confidence: 99%

Near-Infrared Spectroscopy Monitoring in Cardiac and Noncardiac Surgery: Pairwise and Network Meta-Analyses

Ortega-Loubón

Herrera‐Gómez

Bernuy-Guevara

et al. 2019

JCM

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Goal-directed therapy based on brain-oxygen saturation (bSo2) is controversial and hotly debated. While meta-analyses of aggregated data have shown no clinical benefit for brain near-infrared spectroscopy (NIRS)-based interventions after cardiac surgery, no network meta-analyses involving both major cardiac and noncardiac procedures have yet been undertaken. Randomized controlled trials involving NIRS monitoring in both major cardiac and noncardiac surgery were included. Aggregate-level data summary estimates of critical outcomes (postoperative cognitive decline (POCD)/postoperative delirium (POD), acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality) were obtained. NIRS was only associated with protection against POCD/POD in cardiac surgery patients (pooled odds ratio (OR)/95% confidence interval (CI)/I2/number of studies (n): 0.34/0.14–0.85/75%/7), although a favorable effect was observed in the analysis, including both cardiac and noncardiac procedures. However, the benefit of the use of NIRS monitoring was undetectable in Bayesian network meta-analysis, although maintaining bSo2 > 80% of the baseline appeared to have the most pronounced impact. Evidence was imprecise regarding acute kidney injury, cardiovascular events, bleeding/need for transfusion, and postoperative mortality. There is evidence that brain NIRS-based algorithms are effective in preventing POCD/POD in cardiac surgery, but not in major noncardiac surgery. However, the specific target bSo2 threshold has yet to be determined.

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The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position: a randomized blinded study

Cited by 21 publications

References 22 publications

Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

Adverse heart rate responses during beach-chair position for shoulder surgeries - A systematic review and meta-analysis of their incidence, interpretations and associations

PROSPECT guideline for rotator cuff repair surgery: systematic review and procedure‐specific postoperative pain management recommendations

Near-Infrared Spectroscopy Monitoring in Cardiac and Noncardiac Surgery: Pairwise and Network Meta-Analyses

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