The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery
Background Although the safety of the beach-chair position (BCP) is widely accepted, rare devastating neurologic complications have been reported and attributed to cerebral hypoperfusion. Cerebral oxygenation (regional oxygen saturation [rSO2 ]) can be monitored noninvasively using near-infrared spe...
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| Veröffentlicht in: | Journal of shoulder and elbow surgery 2017-09, Vol.26 (9), p.1670-1675 |
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| container_title | Journal of shoulder and elbow surgery |
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| creator | Songy, Chad E., MD Siegel, Eric R., MS Stevens, Mark, MD Wilkinson, John T., MD Ahmadi, Shahryar, MD, FRCSC |
| description | Background Although the safety of the beach-chair position (BCP) is widely accepted, rare devastating neurologic complications have been reported and attributed to cerebral hypoperfusion. Cerebral oxygenation (regional oxygen saturation [rSO2 ]) can be monitored noninvasively using near-infrared spectroscopy. The purpose of this study was to determine the effect of BCP angle on cerebral oxygenation in patients undergoing shoulder surgery in the BCP. Methods Fifty patients undergoing shoulder arthroscopy were prospectively enrolled to participate. Following induction of general anesthesia, each patient's rSO2 was recorded at 0° of elevation and again at 30°, 45°, 60°, and 80° of elevation. Mean rSO2 values and mean differences in rSO2 were reported. Results An average total decrease of 5% in rSO2 was seen when comparing 0° with 80° ( P |
| doi_str_mv | 10.1016/j.jse.2017.03.018 |
| format | Article |
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Cerebral oxygenation (regional oxygen saturation [rSO2 ]) can be monitored noninvasively using near-infrared spectroscopy. The purpose of this study was to determine the effect of BCP angle on cerebral oxygenation in patients undergoing shoulder surgery in the BCP. Methods Fifty patients undergoing shoulder arthroscopy were prospectively enrolled to participate. Following induction of general anesthesia, each patient's rSO2 was recorded at 0° of elevation and again at 30°, 45°, 60°, and 80° of elevation. Mean rSO2 values and mean differences in rSO2 were reported. Results An average total decrease of 5% in rSO2 was seen when comparing 0° with 80° ( P < .001). There were statistically significant differences in rSO2 values at beach-chair angles of 0° versus 30° ( P < .001), 30° versus 45° ( P = .007), and 45° versus 60° ( P < .001) but not between 60° and 80° ( P = .12). The decrease in rSO2 was similar between each progressive increase in the beach-chair angle, leading to a linear decline in rSO2 as the BCP increased (regression slope of −0.060%/°, P < .001). No patient's cerebral oxygenation dropped greater than 20% from baseline. Neither body mass index nor American Society of Anesthesiologists score had a significant impact on the relation of rSO2 to BCP angle. Conclusions The average drop in rSO2 is significantly less than the threshold of 20% used as an identifier for a cerebral deoxygenation event. This study illustrates the direct effect the BCP angle has on cerebral oxygenation.</description><identifier>ISSN: 1058-2746</identifier><identifier>EISSN: 1532-6500</identifier><identifier>DOI: 10.1016/j.jse.2017.03.018</identifier><identifier>PMID: 28478900</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Anesthesia, General ; Arthroplasty, Replacement, Shoulder ; Beach-chair position ; cerebral desaturation event ; cerebral hypoperfusion ; cerebral oxygenation ; Cerebrum - metabolism ; Cohort Studies ; Female ; Humans ; Male ; Middle Aged ; near-infrared spectroscopy ; Orthopedics ; Oxygen - metabolism ; Patient Positioning ; Prospective Studies ; shoulder arthroscopy ; Spectroscopy, Near-Infrared ; Young Adult</subject><ispartof>Journal of shoulder and elbow surgery, 2017-09, Vol.26 (9), p.1670-1675</ispartof><rights>Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>2017 Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c408t-afea248a742a2a4397bf494d439a45e5d7467728a0ddf6b67b12feb32dc33c273</citedby><cites>FETCH-LOGICAL-c408t-afea248a742a2a4397bf494d439a45e5d7467728a0ddf6b67b12feb32dc33c273</cites><orcidid>0000-0002-7130-0305 ; 0000-0001-9824-6612</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jse.2017.03.018$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28478900$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Songy, Chad E., MD</creatorcontrib><creatorcontrib>Siegel, Eric R., MS</creatorcontrib><creatorcontrib>Stevens, Mark, MD</creatorcontrib><creatorcontrib>Wilkinson, John T., MD</creatorcontrib><creatorcontrib>Ahmadi, Shahryar, MD, FRCSC</creatorcontrib><title>The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery</title><title>Journal of shoulder and elbow surgery</title><addtitle>J Shoulder Elbow Surg</addtitle><description>Background Although the safety of the beach-chair position (BCP) is widely accepted, rare devastating neurologic complications have been reported and attributed to cerebral hypoperfusion. Cerebral oxygenation (regional oxygen saturation [rSO2 ]) can be monitored noninvasively using near-infrared spectroscopy. The purpose of this study was to determine the effect of BCP angle on cerebral oxygenation in patients undergoing shoulder surgery in the BCP. Methods Fifty patients undergoing shoulder arthroscopy were prospectively enrolled to participate. Following induction of general anesthesia, each patient's rSO2 was recorded at 0° of elevation and again at 30°, 45°, 60°, and 80° of elevation. Mean rSO2 values and mean differences in rSO2 were reported. Results An average total decrease of 5% in rSO2 was seen when comparing 0° with 80° ( P < .001). There were statistically significant differences in rSO2 values at beach-chair angles of 0° versus 30° ( P < .001), 30° versus 45° ( P = .007), and 45° versus 60° ( P < .001) but not between 60° and 80° ( P = .12). The decrease in rSO2 was similar between each progressive increase in the beach-chair angle, leading to a linear decline in rSO2 as the BCP increased (regression slope of −0.060%/°, P < .001). No patient's cerebral oxygenation dropped greater than 20% from baseline. Neither body mass index nor American Society of Anesthesiologists score had a significant impact on the relation of rSO2 to BCP angle. Conclusions The average drop in rSO2 is significantly less than the threshold of 20% used as an identifier for a cerebral deoxygenation event. This study illustrates the direct effect the BCP angle has on cerebral oxygenation.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia, General</subject><subject>Arthroplasty, Replacement, Shoulder</subject><subject>Beach-chair position</subject><subject>cerebral desaturation event</subject><subject>cerebral hypoperfusion</subject><subject>cerebral oxygenation</subject><subject>Cerebrum - metabolism</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>near-infrared spectroscopy</subject><subject>Orthopedics</subject><subject>Oxygen - metabolism</subject><subject>Patient Positioning</subject><subject>Prospective Studies</subject><subject>shoulder arthroscopy</subject><subject>Spectroscopy, Near-Infrared</subject><subject>Young Adult</subject><issn>1058-2746</issn><issn>1532-6500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUtv1DAUhS0EoqXwA9ggL9kkXD8SJ0JCQhUvqRKLtrtKlmNfzzhk4sFOUOff18MUFixY-Vj3nCPd7xLymkHNgLXvxnrMWHNgqgZRA-uekHPWCF61DcDToqHpKq5ke0Ze5DwCQC-BPydnvJOq6wHOyd3NFil6j3ah0dOl_AY0dlvZrQmJ7mMOS4gzNfNmQlqExYRDMhON94cNzub31K0pzBuat3GdHCaa17TBdHhJnnkzZXz1-F6Q28-fbi6_Vlffv3y7_HhVWQndUhmPhsvOKMkNN1L0avCyl64oIxtsXNlAKd4ZcM63Q6sGxj0OgjsrhOVKXJC3p959ij9XzIvehWxxmsyMcc2adX0rGeMtK1Z2stoUc07o9T6FnUkHzUAfoepRF6j6CFWD0AVqybx5rF-HHbq_iT8Ui-H9yYBlyV8Bk8424GzRhVTAahfDf-s__JO2U5iDNdMPPGAe45rmQk8znbkGfX286vGoTInS0vfiAbo4nQk</recordid><startdate>20170901</startdate><enddate>20170901</enddate><creator>Songy, Chad E., MD</creator><creator>Siegel, Eric R., MS</creator><creator>Stevens, Mark, MD</creator><creator>Wilkinson, John T., MD</creator><creator>Ahmadi, Shahryar, MD, FRCSC</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7130-0305</orcidid><orcidid>https://orcid.org/0000-0001-9824-6612</orcidid></search><sort><creationdate>20170901</creationdate><title>The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery</title><author>Songy, Chad E., MD ; Siegel, Eric R., MS ; Stevens, Mark, MD ; Wilkinson, John T., MD ; Ahmadi, Shahryar, MD, FRCSC</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c408t-afea248a742a2a4397bf494d439a45e5d7467728a0ddf6b67b12feb32dc33c273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia, General</topic><topic>Arthroplasty, Replacement, Shoulder</topic><topic>Beach-chair position</topic><topic>cerebral desaturation event</topic><topic>cerebral hypoperfusion</topic><topic>cerebral oxygenation</topic><topic>Cerebrum - metabolism</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>near-infrared spectroscopy</topic><topic>Orthopedics</topic><topic>Oxygen - metabolism</topic><topic>Patient Positioning</topic><topic>Prospective Studies</topic><topic>shoulder arthroscopy</topic><topic>Spectroscopy, Near-Infrared</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Songy, Chad E., MD</creatorcontrib><creatorcontrib>Siegel, Eric R., MS</creatorcontrib><creatorcontrib>Stevens, Mark, MD</creatorcontrib><creatorcontrib>Wilkinson, John T., MD</creatorcontrib><creatorcontrib>Ahmadi, Shahryar, MD, FRCSC</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of shoulder and elbow surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Songy, Chad E., MD</au><au>Siegel, Eric R., MS</au><au>Stevens, Mark, MD</au><au>Wilkinson, John T., MD</au><au>Ahmadi, Shahryar, MD, FRCSC</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery</atitle><jtitle>Journal of shoulder and elbow surgery</jtitle><addtitle>J Shoulder Elbow Surg</addtitle><date>2017-09-01</date><risdate>2017</risdate><volume>26</volume><issue>9</issue><spage>1670</spage><epage>1675</epage><pages>1670-1675</pages><issn>1058-2746</issn><eissn>1532-6500</eissn><abstract>Background Although the safety of the beach-chair position (BCP) is widely accepted, rare devastating neurologic complications have been reported and attributed to cerebral hypoperfusion. Cerebral oxygenation (regional oxygen saturation [rSO2 ]) can be monitored noninvasively using near-infrared spectroscopy. The purpose of this study was to determine the effect of BCP angle on cerebral oxygenation in patients undergoing shoulder surgery in the BCP. Methods Fifty patients undergoing shoulder arthroscopy were prospectively enrolled to participate. Following induction of general anesthesia, each patient's rSO2 was recorded at 0° of elevation and again at 30°, 45°, 60°, and 80° of elevation. Mean rSO2 values and mean differences in rSO2 were reported. Results An average total decrease of 5% in rSO2 was seen when comparing 0° with 80° ( P < .001). There were statistically significant differences in rSO2 values at beach-chair angles of 0° versus 30° ( P < .001), 30° versus 45° ( P = .007), and 45° versus 60° ( P < .001) but not between 60° and 80° ( P = .12). The decrease in rSO2 was similar between each progressive increase in the beach-chair angle, leading to a linear decline in rSO2 as the BCP increased (regression slope of −0.060%/°, P < .001). No patient's cerebral oxygenation dropped greater than 20% from baseline. Neither body mass index nor American Society of Anesthesiologists score had a significant impact on the relation of rSO2 to BCP angle. Conclusions The average drop in rSO2 is significantly less than the threshold of 20% used as an identifier for a cerebral deoxygenation event. This study illustrates the direct effect the BCP angle has on cerebral oxygenation.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28478900</pmid><doi>10.1016/j.jse.2017.03.018</doi><tpages>6</tpages><orcidid>https://orcid.org/0000-0002-7130-0305</orcidid><orcidid>https://orcid.org/0000-0001-9824-6612</orcidid></addata></record> |
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| subjects | Adult Aged Anesthesia, General Arthroplasty, Replacement, Shoulder Beach-chair position cerebral desaturation event cerebral hypoperfusion cerebral oxygenation Cerebrum - metabolism Cohort Studies Female Humans Male Middle Aged near-infrared spectroscopy Orthopedics Oxygen - metabolism Patient Positioning Prospective Studies shoulder arthroscopy Spectroscopy, Near-Infrared Young Adult |
| title | The effect of the beach-chair position angle on cerebral oxygenation during shoulder surgery |
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