scholarly journals Could Interscalene Block Possibly be Protective Against Cerebral Ischemia During Shoulder Surgery in a Beach Chair Position?

Cureus ◽  
2021 ◽  
Author(s):  
Sami Kaan Coşarcan ◽  
Yavuz Gurkan ◽  
Alper Tunga Doğan ◽  
Özgür Koyuncu ◽  
Ömür Erçelen
Keyword(s):  
Cerebral Ischemia ◽  
Shoulder Surgery ◽  
Interscalene Block ◽  
Beach Chair Position ◽  
Beach Chair

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 <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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