Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position
| Autor: | Harrison H. Lee, Matthew D. Saltzman, Hector Perez, Guido Marra, Justin H. Chan |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Beach chair position medicine.medical_treatment Cerebral oxygen saturation Patient Positioning 03 medical and health sciences 0302 clinical medicine medicine Humans Orthopedics and Sports Medicine Oximetry Prospective Studies Cerebral perfusion pressure Cerebrum Aged Oxygen saturation (medicine) 030222 orthopedics Spectroscopy Near-Infrared business.industry 030229 sport sciences General Medicine Middle Aged Arthroplasty Oxygen Arthroplasty Replacement Shoulder Cerebrovascular Circulation Anesthesia Female Surgery Implant Hypotension Cerebral oxygen business human activities Perfusion |
| Zdroj: | Journal of Shoulder and Elbow Surgery. 29:79-85 |
| ISSN: | 1058-2746 |
| DOI: | 10.1016/j.jse.2019.05.022 |
| Popis: | The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty.Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%.Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi-beach chair positioning. Patients experienced the largest oxygen saturation drop during semi-beach chair positioning. Transition from baseline to semi-beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P.05). There was a statistically significant percentage change in mean oxygen saturation in the semi-beach chair interval (10%, P.01) and the semi-beach chair to incision interval (7%, P.01).Most patients experienced an intraoperative CDE, with greatest incidence during semi-beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi-beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry. |
| Databáze: | OpenAIRE |
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