Review article
WHY MONITORING CEREBRAL DESATURATION EVENTS DURING SURGERY IN THE BEACH CHAIR POSITION?
IVANA HARŠANJI DRENJANČEVIĆ
orcid.org/0000-0003-0871-8562
; Osijek University Hospital Center and Josip Juraj Strossmayer University of Osijek, School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia
SLAVICA KVOLIK
; Osijek University Hospital Center and Josip Juraj Strossmayer University of Osijek, School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Medicine, Osijek, Croatia
DOMAGOJ DRENJANČEVIĆ
; Osijek University Hospital Center, Department of Transfusion Medicine and Josip Juraj Strossmayer University of Osijek, School of Medicine, Department of Microbiology, Parasitology and Clinical Laboratory Diagnostics, Osijek, Croatia
INES DRENJANČEVIĆ
; Josip Juraj Strossmayer University of Osijek, School of Medicine, Department of Physiology and Immunology, Osijek, Croatia
DANIJELA GULAM
; Split University Hospital Center, University of Split, School of Medicine, Department of Anesthesiology, Resuscitation and Intensive Medicine, Split, Croatia
Abstract
Regional cerebral oximeters are used more recently to monitor regional cerebral oxygenation during surgical procedures in which patients are expected to be hemodynamically unstable. Such procedures are cardiac surgery, abdominal surgery that requires anti-Trendelenburg’s position, thoracic surgery with one-lung ventilation, posterior fossa neurosurgery, carotid endarterectomy, and shoulder surgery, performed in the beach chair position (BCP). Patient positioning for particular surgical procedures is extremely important for surgical fi eld visualization, but implies various physiological regulation mechanisms for adaptation to new positions. During patient positioning from supine to other positions, such as BCP, gravity infl uences distribution of the circulating blood volume to the abdomen and extremities. Anesthetized patients have
an altered sympathetic response to position changes, which leads to hypotension, particularly during patient positioning from supine to sitting position. Systemic hypotension that occurs after positioning the patient to BCP is followed by decline in the cerebral perfusion pressure, which can lead to potential cerebrovascular incident. There are several case reports describing visual loss and ophthalmoplegia, postoperative cerebral ischemia with persistent vegetative state or brain death
following these surgical procedures in BCP. Therefore, BCP is a major challenge for the anesthesiologist and for arterial pressure regulation during the surgery due to hypotension. Some investigators found that cerebral blood fl ow was lower with hypotension (measuring blood velocity in middle cerebral artery with transcranial Doppler) in patients during BCP for shoulder arthroscopy. Monitoring cerebral perfusion in patients during shoulder arthroscopy in BCP is suggested by many
authors as a measure to improve patient safety due to potentially endangered brain perfusion. The noninvasive method of the brain oxygenation monitoring is based on the theory of light absorption within the infrared spectrum and uses the near-infrared spectroscopy (NIRS) technology. This monitoring method is user friendly, therefore is gaining much popularity as a method for monitoring cerebral oxygenation. Cerebral desaturation events (CDEs) represent a 20% decline in relation to basal cerebral oxygen saturation values measured with INVOS (In Vivo Optical Spectroscopy, INVOS 5100; Somanetics
Corp., Troy, Michigan, USA) cerebral oximeter and are often recorded during this position. Meex et al. carried out a prospective observational study in volunteers and patients in the lateral decubitus position and BCP to describe changes in cerebral tissue oxygen saturation due to changes in body position. They found that more than 55% of patients in BCP had CDEs as compared with volunteers without anesthesia. As these potential CDEs could be detrimental for neurologic function, the clinicians are constantly trying to fi nd appropriate methods for monitoring cerebral perfusion and the link between hypotension, decreased brain perfusion, decreased brain oxygen saturation and neurological incidents during shoulder arthroscopy in BCP. They are also trying to correlate CDEs with possible neurocognitive changes in patients after these surgical procedures, which has not been confi rmed so far. Salazar et al. found that 18% of patients included in their study had the intraoperative incidence of CDEs during BCP but did not fi nd statistically signifi cant preoperative versus postoperative neurocognitive test scores. They concluded that the transient intraoperative CDEs were not associated with postoperative cognitive dysfunction. Patient safety is strongly ssociated with technical and clinical monitoring capabilities during any surgical procedure; therefore, using all available techniques for supervision of the patient’s vital functions is necessary to minimize the occurrence of potential adverse events.
Keywords
beach chair position; intraoperative monitoring; arterial pressure; spectroscopy; near-infrared; brain hypoxia
Hrčak ID:
197897
URI
Publication date:
3.4.2018.
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