Journal article
The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension: Impact on cerebral oxygenation, cerebral blood flow and neurobehavioral outcome.
- Aguirre JA Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: jose.aguirre@balgrist.ch.
- Etzensperger F Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
- Brada M Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
- Guzzella S Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
- Saporito A Anesthesiology Department, Bellinzona Regional Hospital, 6500 Bellinzona, Switzerland. Electronic address: Andrea.Saporito@eoc.ch.
- Blumenthal S Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: stephan@asblumenthal.ch.
- Bühler P Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland.
- Borgeat A Department of Anesthesiologiy, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland. Electronic address: alain.borgeat@balgrist.ch.
- 2018-10-08
Published in:
- Journal of clinical anesthesia. - 2019
Beach chair position
Cerebral blood flow
Cerebral oxygenation
Intraoperative monitoring
Near-infrared spectroscopy
Neurocognitive outcome
Adult
Anesthesia, General
Anesthetics, Intravenous
Arterial Pressure
Brain
Cerebrovascular Circulation
Cognitive Dysfunction
Female
Humans
Hypotension, Controlled
Hypoxia, Brain
Intraoperative Neurophysiological Monitoring
Male
Middle Aged
Orthopedic Procedures
Oxygen
Patient Positioning
Prospective Studies
Shoulder Joint
English
STUDY OBJECTIVES
The aim of this study was to assess the impact of intravenous general anesthesia and controlled hypotension on cerebral saturation (rScO2), cerebral blood flow measured as middle cerebral artery blood flow velocity (Vmax MCA) and neurobehavioral outcome in patients scheduled for shoulder surgery in beach chair position.
DESIGN
Prospective, assessor-blinded observational study.
SETTING
University hospital, shoulder surgery operating room.
PATIENTS
Forty ASA I-II patients scheduled for shoulder surgery in beach chair position and controlled hypotension.
INTERVENTIONS
Neurological and neurobehavioral tests were performed prior and the day after surgery. The baseline data for near-infrared spectroscopy, bispectral index, cerebral blood flow, PaCO2 and invasive blood pressure (radial artery) were taken prior anesthesia and after anesthesia induction, after beach chair positioning and all 20 min after surgery start until discharge of the patient.
MEASUREMENTS
Neurological and neurobehavioral tests, cerebral saturation (rScO2) using near-infrared spectroscopy, BIS, cerebral blood flow using Doppler of the middle cerebral artery (Vmax MCA), PaCO2 and invasive blood pressure assessed at heart and at the external acoustic meatus level.
MAIN RESULTS
The incidence of cerebral desaturation events (CDEs) was 25%. The blood pressure drop 5 min after beach chair position measured at the acoustic meatus level in the CDE group was higher compared to patients without CDEs (p = 0.009) as was the rScO2 (p = 0.039) and the Vmax MCA (p = 0.002). There were no neurological deficits but patients with CDEs showed a greater negative impact on neurobehavioral tests 24 h after surgery compared to patients without CDEs (p = 0.001).
CONCLUSIONS
In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with impact on the neurobehavioral outcome.
The aim of this study was to assess the impact of intravenous general anesthesia and controlled hypotension on cerebral saturation (rScO2), cerebral blood flow measured as middle cerebral artery blood flow velocity (Vmax MCA) and neurobehavioral outcome in patients scheduled for shoulder surgery in beach chair position.
DESIGN
Prospective, assessor-blinded observational study.
SETTING
University hospital, shoulder surgery operating room.
PATIENTS
Forty ASA I-II patients scheduled for shoulder surgery in beach chair position and controlled hypotension.
INTERVENTIONS
Neurological and neurobehavioral tests were performed prior and the day after surgery. The baseline data for near-infrared spectroscopy, bispectral index, cerebral blood flow, PaCO2 and invasive blood pressure (radial artery) were taken prior anesthesia and after anesthesia induction, after beach chair positioning and all 20 min after surgery start until discharge of the patient.
MEASUREMENTS
Neurological and neurobehavioral tests, cerebral saturation (rScO2) using near-infrared spectroscopy, BIS, cerebral blood flow using Doppler of the middle cerebral artery (Vmax MCA), PaCO2 and invasive blood pressure assessed at heart and at the external acoustic meatus level.
MAIN RESULTS
The incidence of cerebral desaturation events (CDEs) was 25%. The blood pressure drop 5 min after beach chair position measured at the acoustic meatus level in the CDE group was higher compared to patients without CDEs (p = 0.009) as was the rScO2 (p = 0.039) and the Vmax MCA (p = 0.002). There were no neurological deficits but patients with CDEs showed a greater negative impact on neurobehavioral tests 24 h after surgery compared to patients without CDEs (p = 0.001).
CONCLUSIONS
In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with impact on the neurobehavioral outcome.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.jclinane.2018.09.035
- PMID 30292739
- Persistent URL
- https://sonar.ch/global/documents/58638
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