Beach Chair Position Anaesthesia

Secure the head to an appropriate head rest and secure the oral tube. This is a PDF-only article.

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Pdf Compartment Syndrome Due To Patient Positioning

1 In 2005 Pohl and Cullen published a 4-patient case series describing catastrophic cerebral ischemia in patients undergoing shoulder surgery in the BCP.

Beach chair position anaesthesia. 7 evaluated the incidence of cerebral desaturation during shoulder surgery in the beach chair position compared to the lateral decubitus position. It is helpful to place the trunk almost upright with an almost hanging arm to help reduce the fracture by ligamentotaxis and gravity. 2 This series has prompted investigators to study how intraoperative management factors blood pressure type of anesthesia.

Agents with greater preservation of cerebral blood flow CBF to cerebral metabolic rate for oxygen CMR o2 ratio. Surgical field above the heart If neuro. Hypocarbia reduces CBF and oxygen delivery.

However cerebral ischemic events have been observed after surgery in BCP 3 4 identifying the upright position as an independent risk factor for cerebral ischemia during the perioperative period. The beach chair position BCP is commonly used for arthroscopic and open shoulder procedures and offers different advantages compared to the lateral decubitus position LDP 12. 11 Furthermore it allows for easy airway access if complications arise during surgery and the patient needs to be placed in the supine position.

Anesthetic agents have distinct effects on cerebral hemodynamics and metabolism 14 15 which may have implications for beach chair positioning. According to a report by Murphy et al3 shoulder surgery in the beach chair position was associated with a significant reduction in cerebral oxygenation. Cerebral oxygenation for patients anesthetized in the beach chair position Anesthetic agents have differing effects on the brain but there is no proven benefit.

Anaesthesia in the beach chair position commonly causes systemic hypotension. Although some studies have identified this as a risk it is still a rare complication albeit devastating. Bring the torso up into the beach chair position.

Although shoulder surgery can be conducted in the lateral decubitus position the majority of surgeons in the United States use the sitting or beach chair position BCP. A prospective study on the effect of general anesthesia compared with regional anesthesia and sedation. That the use of the beach chair position under general anesthesia did not alter cerebral oxygenation several studies have reported a causal relationship between the beach chair position and cerebral hypoperfusion34.

In the presented study non-invasive cerebral oxygenation monitorization was performed in 53 patients who had arthroscopic rotator cuff repair surgery. The association of anesthesia in the sitting beach-chair position with intra-operative stroke continues to be controversial. Effects of the Beach Chair Position Positive End-expiratory Pressure and Pneumoperitoneum on Respiratory Function in Morbidly Obese Patients during Anesthesia and Paralysis Anesthesiology November 2007.

They used standardised anaesthetic management and aimed to optimise cerebral perfusion by maintaining MAP within 20 of baseline values and controlling EtCO 2 between 30 and 34 mmHg. Remote airway Reinforced ETT Well-secured to face Connections jammed in Cerebral hypoperfusion Hips flexed Start supine and raise slowly Metaraminol infusion Arterial line with transducer at brainstem level Venous embolism. It may also reduce cerebral blood flow CBF and oxygenation.

The beach-chair position also offers the flexibility of using general or regional anesthesia for the procedure. Murphy et al. This combination of the beach chair position and induced hypotension under general anaesthesia has the potential to induce cerebral ischaemia and increase related complications 5 7 9.

Cerebral oxygenation in the beach chair position. In ASA I-II patients intravenous general anesthesia and controlled hypotension in the beach chair position affects cerebral blood flow and cerebral oxygenation with. The authors report fewer cerebral desaturation events when ventilation is adjusted to achieve E C O 2 of 4042 when compared with 3032 mm Hg.

The first page of the PDF of this article appears above. J Shoulder Elbow.