Abstract
Background: It is well known that patients undergoing shoulder surgery in the Beach Chair Position (BCP) have a potential risk for cerebral ischemia. Using Near-Infrared Spectroscopy (NIRS), this study aimed to test whether cerebral oxygenation in these patients was impaired by brachial plexus block accompanied with general anesthesia. Methods: Ultrasound-guided interscalene brachial plexus block was performed in 26 patients undergoing elective arthroscopic shoulder surgery under general anesthesia. In all subjects, cerebral oxygenation during anesthesia was evaluated by measuring the Tissue Oxygenation Index (TOI) with NIRS. Results: No differences were seen in TOI values between Pre-BCP and Post-BCP periods in both block and non-block sides, despite a decrease in mean blood pressure (P<0.05, repeated measures one-way ANOVA by the Bonferroni post hoc test). Additionally, no differences were seen in TOI values between block and non-block sides at any time point. Conclusion: Changing from the supine position to the BCP did not appear to impair cerebral oxygenation, regardless of brachial plexus block, in patients undergoing shoulder arthroscopy under general anesthesia.
Highlights
As a result of advanced surgical techniques, shoulder surgery and arthroscopy have become increasingly common orthopedic procedures in recent years
Baroreceptor responses after a change in position are blunted under general anesthesia, resulting in attenuation of the increase in systemic vascular resistance, a decrease in mean arterial pressure, and a greater reduction in cardiac output compared with the awake state [4]
Using Near-Infrared Spectroscopy (NIRS), this study aimed to test whether cerebral oxygenation was impaired in patients undergoing shoulder arthroscopy in the Beach Chair Position (BCP) under general anesthesia with brachial plexus block
Summary
As a result of advanced surgical techniques, shoulder surgery and arthroscopy have become increasingly common orthopedic procedures in recent years. After several reports of injuries to the brachial plexus and forearm nerves associated with the traditional lateral decubitus position, the Beach Chair Position (BCP) has become standard for shoulder surgery since the mid-to-late 1980s. Recent studies have demonstrated that NIRS is capable of providing similar accuracy as transcranial Doppler sonography or stump pressure measurements for the detection of cerebral ischemia during carotid surgery [5]. Past studies suggested that NIRS is suitable to directly compare cerebral oxygenation between cerebral hemispheres after nerve blocks [6,7]. It is well known that patients undergoing shoulder surgery in the Beach Chair Position (BCP) have a potential risk for cerebral ischemia. Using Near-Infrared Spectroscopy (NIRS), this study aimed to test whether cerebral oxygenation in these patients was impaired by brachial plexus block accompanied with general anesthesia
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