Foreseeing the danger in the beach chair position: Are standard measurement methods reliable?

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 23; no. 9; pp. 2639 - 2644
• Main Authors: Kocaoglu, Baris, Ozgen, Serpil Ustalar, Toraman, Fevzi, Karahan, Mustafa, Guven, Osman
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2015; Springer Nature B.V
• Subjects: Adult; Aged; Arthroscopy; Biomarkers - metabolism; Blood Pressure Determination; Brain - metabolism; Brain Ischemia - diagnosis; Brain Ischemia - etiology; Brain Ischemia - metabolism; Electrocardiography; Female; General anesthesia; Heart Rate; Hospitals; Humans; Hypotension; Intraoperative Complications - diagnosis; Intraoperative Complications - etiology; Intraoperative Complications - metabolism; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Oximetry; Oxygen - metabolism; Oxygen saturation; Patient Positioning - adverse effects; Patient Positioning - methods; Patients; Prospective Studies; Rotator cuff; Rotator Cuff - surgery; Rotator Cuff Injuries; Shoulder; Spectroscopy, Near-Infrared; Spectrum analysis; Surgeons; Surgery; Tendon Injuries - surgery; University faculty; Istanbul Turkey; Turkey; Cerebral desaturation; Near-infrared spectroscopy (NIRS); Beach chair position; Rotator cuff repair
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-014-3090-6

Purpose The aim of this study is to show whether peripheral perfusion monitoring methods reflect central perfusion during shoulder arthroscopy at beach chair position. We hypothesized that mean arterial pressure (MAP), central heart rate (CHR) and peripheral oxygenation (SaO 2 ) measurements individually will not parallel cerebral oximetry measurements by near-infrared spectroscopy (NIRS). Methods Between 2011 and 2012, 53 patients who had arthroscopic rotator cuff repair surgery in the beach chair position were enrolled prospectively. Median ages of the patients were 58 (range 42–68) years. The regional cerebral oxygen saturation value of each hemisphere was continuously monitored by the use of NIRS. MAP, CHR, SaO 2 and both hemispheric cerebral oxygen saturation values were recorded at six time periods peri-operatively. Correlation and differences between parameters were evaluated. Results Cerebral oxygen saturation of right hemisphere was dropped >20 % in 28.3 and 45.3 % of the patients. At left hemisphere, cerebral oxygen saturation was dropped >20 % in 20.8 and 43.4 % of the patients. Peripheral saturation values were statistically different from cerebral saturation values ( p  < 0.001). On the other hand, there was a correlation between cerebral saturation and MAP values ( p  < 0.05). Conclusion Cerebral oximetry by NIRS may prove useful as a monitor for cerebral ischaemia. In the absence of NIRS, CHR can partially detect abnormalities but not trustable, and MAP is the most reliable method for monitoring. Level of evidence III.