Document Detail


Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: Comparing general to regional anesthesia and the impact on neurobehavioral outcome.
MedLine Citation:
PMID:  24119783     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Ischemic brain damage has been reported in healthy patients after beach chair position for surgery due to cerebral hypoperfusion. Near-infrared spectroscopy has been described as a non-invasive, continuous method to monitor cerebral oxygen saturation. However, its impact on neurobehavioral outcome comparing different anesthesia regimens has been poorly described.
METHODS: In this prospective, assessor-blinded study, 90 patients undergoing shoulder surgery in beach chair position following general (G-group, n=45) or regional anesthesia (R-group; n=45) were enrolled to assess the prevalence of cerebral desaturation events comparing anesthesia regimens and their impact on neurobehavioral and neurological outcome. Anesthesiologists were blinded to regional cerebral oxygen saturation values. Baseline data assessed the day before surgery included neurological and neurobehavioral tests, which were repeated the day after surgery. The baseline data for regional cerebral oxygen saturation/bispectral index and invasive blood pressure both at heart and auditory meatus levels were taken prior to anesthesia, 5min after induction of anesthesia, 5min after beach chair positioning, after skin incision and thereafter all 20min until discharge.
RESULTS: Patients in the R-group showed significantly less cerebral desaturation events (p<0.001), drops in regional cerebral oxygen saturation values (p<0.001), significantly better neurobehavioral test results the day after surgery (p<0.001) and showed a greater hemodynamic stability in the beach chair position compared to patients in the G-group.
CONCLUSIONS: The incidence of regional cerebral oxygen desaturations seems to influence the neurobehavioral outcome. Regional anesthesia offers more stable cardiovascular conditions for shoulder surgery in beach chair position influencing neurobehavioral test results at 24h.
Authors:
J Aguirre; A Borgeat; T Trachsel; I Cobo Del Prado; J De Andrés; P Bühler
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-9
Journal Detail:
Title:  Revista espanola de anestesiologia y reanimacion     Volume:  -     ISSN:  2340-3284     ISO Abbreviation:  Rev Esp Anestesiol Reanim     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0134516     Medline TA:  Rev Esp Anestesiol Reanim     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.
Affiliation:
Division of Anesthesiology, Balgrist University Hospital, Zurich, Switzerland. Electronic address: jose.aguirre@balgrist.ch.
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