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Cerebral oxygen desaturation during beach chair position

ANNELIESE MOERMAN UGent, Stefan De Hert UGent, TOM JACOBS UGent, Lieven De Wilde UGent and Patrick Wouters UGent (2012) EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 29(2). p.82-87
abstract
Context Cases of ischaemic brain damage have been reported in relatively healthy patients undergoing shoulder surgery in the beach chair position. Unrecognised cerebral hypoperfusion may have contributed to these catastrophic events, indicating that routine anaesthesia monitoring may not suffice. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to measure regional cerebral oxygen saturation (rS(c)O(2)). Objectives The aim of this clinical investigation was to evaluate the prevalence of regional cerebral oxygen desaturation in patients undergoing shoulder surgery in the upright position during routine anaesthesia management. We also aimed to identify some causal factors for cerebral desaturation. Design Prospective, observational, blinded study. Setting University hospital. Observation period from 19 05 2008 to 26 08 2008. Patients Twenty consecutive adult patients presenting for elective shoulder surgery under general anaesthesia in the beach chair position were enrolled. Patients with clinically apparent neurological or cognitive dysfunction were excluded. Interventions Routine anaesthesia management and standard monitoring were used. The responsible anaesthesiologist was blinded to the rS(c)O(2) data and was not informed about the purpose of the study. Main outcome measures The prevalence of cerebral oxygen desaturation was measured. Results With beach chair positioning, rS(c)O(2) decreased significantly from 79 +/- 9 to 57 +/- 9% on the left side and from 77 perpendicular to 10 to 59 perpendicular to 10% on the right side (P<0.001). A relative decrease in rS(c)O(2) of more than 20% occurred in 80% of patients when the beach chair position was adopted. Postural decreases in cerebral oxygenation were related to blood pressure (r = 0.60, P = 0.007) and end-tidal carbon dioxide concentration (r = 0.47, P = 0.035). Conclusion The high prevalence of significant cerebral oxygen desaturation during shoulder surgery in the upright position underlines the need for close monitoring. NIRS might constitute a valuable technique to detect cerebral hypoperfusion in this high-risk group of patients.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
monitoring, near-infrared spectroscopy, cerebral oximetry, patient positioning, SHOULDER SURGERY, GENERAL-ANESTHESIA, CARBON-DIOXIDE, SATURATION, OXIMETRY, PERFUSION, PRESSURE, HYPOXIA, POSTURE, PATIENT
journal title
EUROPEAN JOURNAL OF ANAESTHESIOLOGY
Eur. J. Anaesthesiol.
volume
29
issue
2
pages
82 - 87
Web of Science type
Article
Web of Science id
000299167600005
ISSN
1365-2346
DOI
10.1097/EJA.0b013e328348ca18
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
1917554
handle
http://hdl.handle.net/1854/LU-1917554
date created
2011-09-29 13:17:55
date last changed
2012-02-23 13:37:11
@article{1917554,
  abstract     = {Context Cases of ischaemic brain damage have been reported in relatively healthy patients undergoing shoulder surgery in the beach chair position. Unrecognised cerebral hypoperfusion may have contributed to these catastrophic events, indicating that routine anaesthesia monitoring may not suffice. Near-infrared spectroscopy (NIRS) provides a non-invasive, continuous method to measure regional cerebral oxygen saturation (rS(c)O(2)). 
Objectives The aim of this clinical investigation was to evaluate the prevalence of regional cerebral oxygen desaturation in patients undergoing shoulder surgery in the upright position during routine anaesthesia management. We also aimed to identify some causal factors for cerebral desaturation. 
Design Prospective, observational, blinded study. 
Setting University hospital. Observation period from 19 05 2008 to 26 08 2008. 
Patients Twenty consecutive adult patients presenting for elective shoulder surgery under general anaesthesia in the beach chair position were enrolled. Patients with clinically apparent neurological or cognitive dysfunction were excluded. 
Interventions Routine anaesthesia management and standard monitoring were used. The responsible anaesthesiologist was blinded to the rS(c)O(2) data and was not informed about the purpose of the study. 
Main outcome measures The prevalence of cerebral oxygen desaturation was measured. 
Results With beach chair positioning, rS(c)O(2) decreased significantly from 79 +/- 9 to 57 +/- 9\% on the left side and from 77 perpendicular to 10 to 59 perpendicular to 10\% on the right side (P{\textlangle}0.001). A relative decrease in rS(c)O(2) of more than 20\% occurred in 80\% of patients when the beach chair position was adopted. Postural decreases in cerebral oxygenation were related to blood pressure (r = 0.60, P = 0.007) and end-tidal carbon dioxide concentration (r = 0.47, P = 0.035). 
Conclusion The high prevalence of significant cerebral oxygen desaturation during shoulder surgery in the upright position underlines the need for close monitoring. NIRS might constitute a valuable technique to detect cerebral hypoperfusion in this high-risk group of patients.},
  author       = {MOERMAN, ANNELIESE and De Hert, Stefan and JACOBS, TOM and De Wilde, Lieven and Wouters, Patrick},
  issn         = {1365-2346},
  journal      = {EUROPEAN JOURNAL OF ANAESTHESIOLOGY},
  keyword      = {monitoring,near-infrared spectroscopy,cerebral oximetry,patient positioning,SHOULDER SURGERY,GENERAL-ANESTHESIA,CARBON-DIOXIDE,SATURATION,OXIMETRY,PERFUSION,PRESSURE,HYPOXIA,POSTURE,PATIENT},
  language     = {eng},
  number       = {2},
  pages        = {82--87},
  title        = {Cerebral oxygen desaturation during beach chair position},
  url          = {http://dx.doi.org/10.1097/EJA.0b013e328348ca18},
  volume       = {29},
  year         = {2012},
}

Chicago
MOERMAN, ANNELIESE, Stefan De Hert, TOM JACOBS, Lieven De Wilde, and Patrick Wouters. 2012. “Cerebral Oxygen Desaturation During Beach Chair Position.” European Journal of Anaesthesiology 29 (2): 82–87.
APA
MOERMAN, ANNELIESE, De Hert, S., JACOBS, T., De Wilde, L., & Wouters, P. (2012). Cerebral oxygen desaturation during beach chair position. EUROPEAN JOURNAL OF ANAESTHESIOLOGY, 29(2), 82–87.
Vancouver
1.
MOERMAN A, De Hert S, JACOBS T, De Wilde L, Wouters P. Cerebral oxygen desaturation during beach chair position. EUROPEAN JOURNAL OF ANAESTHESIOLOGY. 2012;29(2):82–7.
MLA
MOERMAN, ANNELIESE, Stefan De Hert, TOM JACOBS, et al. “Cerebral Oxygen Desaturation During Beach Chair Position.” EUROPEAN JOURNAL OF ANAESTHESIOLOGY 29.2 (2012): 82–87. Print.