scholarly journals Effect of Beach-Chair Position on Cerebral Blood Flow in Patients Undergoing Shoulder Surgery—A Preliminary Observational Study

2021 ◽  
Author(s):  
Jesudoss Antony ◽  
Georgene Singh ◽  
Bijesh Yadav ◽  
Melvin A. Abraham ◽  
Sajan P. George
Keyword(s):  
Cerebral Perfusion ◽  
Point Of Care ◽  
Shoulder Surgery ◽  
Cerebral Hypoperfusion ◽  
Temporal Window ◽  
Noninvasive Technique ◽  
Beach Chair Position ◽  
Significant Linear Correlation ◽  
The Mean ◽  
Beach Chair

Abstract Background Hypotension and cerebral hypoperfusion, commonly encountered in beach-chair position under general anesthesia, carry the risk of neurologic complications. There is a paucity of data on monitoring cerebral perfusion. Our objective was to compare the mean arterial pressure (MAP) and middle cerebral artery velocity (Vmca) in the supine and beach-chair position and estimate its correlation during hypotension. Materials and Methods Twenty ASA class I and II patients undergoing elective shoulder surgery in beach-chair position were included in the study. MAP was measured invasively with the pressure transducer leveled to the phlebostatic axis. Vmca was measured with a 2 MHz transcranial Doppler (TCD) probe through the temporal window. Both MAP and Vmca were measured at baseline after anesthetic induction in the supine position (BL), on assuming the beach-chair position (AP), at steady-state hemodynamics in beach-chair position (P1), whenever there was a drop in MAP > 20% (P2), and on the restoration of MAP (P3). Results A mean decrease in MAP and Vmca by 24.76% and 27.96%, respectively, from supine to beach-chair position with a significant linear correlation between MAP and Vmca along with a Pearsons’ coefficient of 0.77 was seen. A change in MAP of 1 mm of Hg resulted in a change in Vmca by 0.53 cm/sec (p < 0.05). Conclusion A significant decrease in MAP and Vmca was observed in the beach-chair position. TCD could be used as a point-of-care noninvasive technique to reliably assess cerebral perfusion.

scholarly journals Non-invasive continuous blood pressure monitoring (ClearSight™ system) during shoulder surgery in the beach chair position: a prospective self-controlled study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Konrad Chachula ◽  
Florian Lieb ◽  
Florian Hess ◽  
Joellen Welter ◽  
Nicole Graf ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Pressure Monitoring ◽  
Shoulder Surgery ◽  
Controlled Study ◽  
Pressure Monitoring ◽  
Non Invasive ◽  
Arterial Blood ◽  
Beach Chair Position ◽  
The Mean ◽  
Beach Chair

Abstract Background The beach chair position that is commonly used in shoulder surgery is associated with relative hypovolemia, which leads to a reduction in arterial blood pressure. The effects of patient positioning on the accuracy of non-invasive continuous blood pressure monitoring with the ClearSight™ system (CS-BP; Edwards Lifesciences, Irvine CA, USA) have not been studied extensively. Our research aim was to assess agreement levels between CS-BP measurements with traditional blood pressure monitoring techniques. Methods For this prospective self-controlled study, we included 20 consecutively treated adult patients undergoing elective shoulder surgery in the beach chair position. We performed Bland-Altman analyses to determine agreement levels between blood pressure values from CS-BP and standard non-invasive (NIBP) methods. Perioperative measurements were done in both the supine (as reference) and beach chair surgical positions. Additionally, we compared invasive blood pressure (IBP) measurements with both the non-invasive methods (CS-BP and NIBP) in a sub-group of patients (n = 10) who required arterial blood pressure monitoring. Results We analyzed 229 data points (116 supine, 113 beach chair) from the entire cohort; per patient measurements were based on surgical length (range 3–9 supine, 2–10 beach chair). The mean difference (±SD; 95% limits of agreement) in the mean arterial pressure (MAP) between CS-BP and NIBP was − 0.9 (±11.0; − 24.0–22.2) in the beach chair position and − 4.9 mmHg (±11.8; − 28.0–18.2) when supine. In the sub-group, the difference between CS-BP and IBP in the beach chair position was − 1.6 mmHg (±16.0; − 32.9–29.7) and − 2.8 mmHg (±15.3; − 32.8–27.1) in the supine position. Between NIBP and IBP, we detected a difference of 3.0 mmHg (±9.1; − 20.8–14.7) in the beach chair position, and 4.6 mmHg (±13.3; − 21.4–30.6) in the supine position. Conclusions We found clinically acceptable mean differences in MAP measurements between the ClearSight™ and non-invasive oscillometric blood pressure systems when patients were in either the supine or beach chair position. For all comparisons of the monitoring systems and surgical positions, the standard deviations and limits of agreement were wide. Trial registration This study was prospectively registered at the German Clinical Trial Register (www.DRKS.de; DRKS00013773). Registered 26/01/2018.

scholarly journals Hoarseness After Shoulder Surgery in Beach-chair Position

2021 ◽  
Author(s):  
Seung-Min Youn ◽  
Sung-Min Rhee ◽  
Hwan Jin Kim ◽  
Hyun Woo Lee ◽  
Seong Cheol Moon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Vocal Cord ◽  
Recovery Time ◽  
Shoulder Surgery ◽  
Worst Case ◽  
Beach Chair Position ◽  
Cord Injury ◽  
Spine Radiographs ◽  
Beach Chair

Abstract Background Isolated vocal cord palsy resulting hoarseness after shoulder surgery in beach-chair position had not been reported in literature to date. The purpose of this study was to review its incidence in our patient cohort, and identify any risk factors that may predispose the patient to the injury.Methods There were 10215 operative shoulder cases from January 2010 to December 2017. Inclusion criteria was any post-operative patients, whose operation was performed under general anesthesia in beach-chair position, who had the related symptoms, but the diagnoses had to be confirmed by otorhinolaryngologists with laryngoscopy studies. The affected patients’ clinical notes were retrospectively reviewed with the particular interest in the operative times, and the peri-operative cervical spine radiographs. The degree of cervical spine lordosis was assessed using a method described in literature, in which ‘absolute rotation angle’ (ARA) was measured. Results There were 8 reported cases of vocal cord injury in total (0.08%). Four were male patients and four were arthroscopic cases. The mean age was 59.4 ± 11.9 years old. No particular difficulties with positioning or intubation were documented. The average duration of anesthetic times was 141 minutes. On peri-operative cervical spine radiographs, the average lordosis was 8.2° (1.5° kyphosis - 21° lordosis), and except for one patient, all had ‘non-lordotic’ type curvatures. All but one patient had recovered fully with observation and expectant management, with the average recovery time being 19 weeks (range: 2 weeks to 1 year). Only patient who had not recovered during our 2-year follow-up period, had a ‘sigmoidal’ type cervical spine and was also managed with observation only.Conclusions The incidence of vocal cord injury with beach-chair positioning at our institution was low at 0.08%. The possible risk factors include long duration of the procedure and ‘non-lordotic’ cervical spine, as demonstrated by the trend in our study. Although rare, vocal cord injury has varying duration of recovery time, in the worst-case scenario being permanent, therefore it needs to be avoided by taking utmost care during positioning of the patient in beach-chair. Level of Evidence Level IV, case series

scholarly journals More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position

2011 ◽  
Vol 58 (11) ◽  
pp. 993-1000 ◽  
Author(s):  
Terrence L. Trentman ◽  
Sharon L. Fassett ◽  
Justin K. Thomas ◽  
Brie N. Noble ◽  
Kevin J. Renfree ◽  
...  
Keyword(s):  
Shoulder Surgery ◽  
Beach Chair Position ◽  
Beach Chair

The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery

2017 ◽  
Vol 26 (9) ◽  
pp. 1670-1675 ◽  
Author(s):  
Chad E. Songy ◽  
Eric R. Siegel ◽  
Mark Stevens ◽  
John T. Wilkinson ◽  
Shahryar Ahmadi
Keyword(s):  
Cerebral Oxygenation ◽  
Position Angle ◽  
Shoulder Surgery ◽  
Beach Chair Position ◽  
Beach Chair

scholarly journals Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in Beach Chair Position under Sevoflurane-Nitrous Oxide or Propofol-Remifentanil Anesthesia

2012 ◽  
Vol 116 (5) ◽  
pp. 1047-1056 ◽  
Author(s):  
Hyejin Jeong ◽  
Seongtae Jeong ◽  
Hoi J. Lim ◽  
JongUn Lee ◽  
Kyung Y. Yoo
Keyword(s):  
Nitrous Oxide ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Oxygen Saturation ◽  
Cerebral Oxygenation ◽  
Shoulder Surgery ◽  
Tissue Oxygen Saturation ◽  
Beach Chair Position ◽  
Beach Chair ◽  
Jugular Venous Bulb

Background We examined the effects of different anesthetics on cerebral oxygenation and systemic hemodynamics in patients undergoing surgery in beach chair position (BCP). Jugular venous bulb oxygen saturation (SjvO2) and regional cerebral tissue oxygen saturation (SctO2) were determined while patients were placed from the supine to BCP. Whether SctO2 and SjvO2 are interchangeable in assessing the cerebral oxygenation was also examined. Methods Forty patients undergoing shoulder surgery in BCP were randomly assigned to receive sevoflurane-nitrous oxide (S/N) or propofol-remifentanil (P/R) anesthesia. Four patients taking angiotensin II receptor antagonists were excluded post hoc. Mean arterial pressure and heart rate, as well as SjvO2 and SctO2, were measured before (postinduction baseline in supine position) and after BCP. Results Mean arterial pressure decreased by BCP in both groups. It was, however, significantly higher in S/N (n = 19) than in P/R group (n = 17) at 7 to 8 min after the positioning. SjvO2 also significantly decreased after BCP in both groups, the magnitude of which was lower in S/N than in P/R group (11 ± 10% vs. 23 ± 9%, P = 0.0006). The incidences of SjvO2 &lt;50% and mean arterial pressure less than 50 mmHg were lower in S/N group, but SctO2and the incidence of cerebral desaturation (more than 20% decrease from baseline) did not significantly differ between the groups. SctO2 and SjvO2 were only weakly correlated (β = 0.218, r2 = 0.133). Bland-Altman analysis showed a mean difference of -7.2% with 95% limit of agreement between -38.2% and 23.8%. Conclusions The margin of safety against impaired cerebral oxygenation is greater and SjvO2 is more preserved with S/N than with P/R anesthesia. SctO2 may not be reliable in detecting a low SjvO2 during the surgery in BCP.

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