Open AccessSafety of Beach Chair Position Shoulder Surgery: A Review of the Current Literature
Author(s) -
Glenn Murphy,
Steven B. Greenberg,
Joseph W. Szokol
Publication year - 2019
Publication title -
anesthesia and analgesia/anesthesia and analgesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.404
H-Index - 201
eISSN - 1526-7598
pISSN - 0003-2999
DOI - 10.1213/ane.0000000000004133
Subject(s) - medicine , anesthesia , cerebral blood flow , adverse effect , cerebral perfusion pressure , prone position , etiology , surgery , cerebral autoregulation , intracranial pressure , stroke (engine) , blood pressure , autoregulation , mechanical engineering , engineering
Although uncommon, severe neurological events have been reported in patients undergoing shoulder surgery in the beach chair position. The presumed etiology of central nervous system injury is hypotension and subsequent cerebral hypoperfusion that occurs after alterations in positioning under general anesthesia. Most clinical trials have demonstrated that beach chair positioning results in reductions in regional brain oxygenation, cerebral blood flow, and jugular bulb oxygenation, as well as impairment in cerebral autoregulation and electroencephalographic/processed electroencephalographic variables. Further studies are needed to define the incidence of adverse neurological adverse events in the beach chair position, identify the best intraoperative neurological monitors that are predictive of neurocognitive outcomes, the lowest "safe" acceptable blood pressure during surgery for individual patients, and the optimal interventions to treat intraoperative hypotension.