Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia

Sushil Pant; Desmond J. Bokor; Adrian K. Low

doi:10.1016/j.arthro.2014.05.042

Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia

Sushil Pant, Desmond J. Bokor, Adrian K. Low

Department of Clinical Medicine

Research output: Contribution to journal › Review article › peer-review

28 Citations (Scopus)

Abstract

Purpose: To examine the risks of shoulder arthroscopy in the beach-chair position (BCP) as opposed to the lateral decubitus position. The challenge during general anesthesia, particularly with the patient in the BCP, has been to ascertain the lower limit of blood pressure autoregulation, correctly measure mean arterial pressure, and adequately adjust parameters to maintain cerebral perfusion. There is increasing concern about the BCP and its association with intraoperative cerebral desaturation events (CDEs). Assessment of CDEs intraoperatively remains difficult; the emerging technology near-infrared spectroscopy (NIRS) may provide noninvasive, inexpensive, and continuous assessment of cerebral perfusion, offering an "early warning" system before irreversible cerebral ischemia occurs.

Methods: A systematic review was undertaken to determine the incidence of intraoperative CDEs as measured by NIRS and whether it is possible to risk stratify patients for intraoperative CDEs, specifically the degree of elevation in the BCP.

Results: Searching Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 30, 2013, we found 9 studies (N = 339) that met our search criteria. The Level of Evidence was III or IV.

Conclusions: There remains a paucity of high-level data. The mean incidence of CDEs was 28.8%. We found a strong positive correlation between CDEs and degree of elevation in the BCP (P = .056). Emerging evidence (Level IV) suggests that we may be able to stratify patients on the basis of age, history of hypertension and stroke, body mass index, diabetes mellitus, obstructive sleep apnea, and height. The challenge remains, however, in defining the degree and duration of cerebral desaturation, as measured by NIRS, required to produce measureable neurocognitive decline postoperatively.

Level of Evidence: Level IV, systematic review of Level III and IV studies.

Original language	English
Pages (from-to)	1520-1527
Number of pages	8
Journal	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
Volume	30
Issue number	11
DOIs	https://doi.org/10.1016/j.arthro.2014.05.042
Publication status	Published - 1 Nov 2014

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10.1016/j.arthro.2014.05.042

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Pant, S., Bokor, D. J., & Low, A. K. (2014). Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 30(11), 1520-1527. https://doi.org/10.1016/j.arthro.2014.05.042

Pant, Sushil ; Bokor, Desmond J. ; Low, Adrian K. / Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. In: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2014 ; Vol. 30, No. 11. pp. 1520-1527.

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abstract = "Purpose: To examine the risks of shoulder arthroscopy in the beach-chair position (BCP) as opposed to the lateral decubitus position. The challenge during general anesthesia, particularly with the patient in the BCP, has been to ascertain the lower limit of blood pressure autoregulation, correctly measure mean arterial pressure, and adequately adjust parameters to maintain cerebral perfusion. There is increasing concern about the BCP and its association with intraoperative cerebral desaturation events (CDEs). Assessment of CDEs intraoperatively remains difficult; the emerging technology near-infrared spectroscopy (NIRS) may provide noninvasive, inexpensive, and continuous assessment of cerebral perfusion, offering an {"}early warning{"} system before irreversible cerebral ischemia occurs.Methods: A systematic review was undertaken to determine the incidence of intraoperative CDEs as measured by NIRS and whether it is possible to risk stratify patients for intraoperative CDEs, specifically the degree of elevation in the BCP.Results: Searching Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 30, 2013, we found 9 studies (N = 339) that met our search criteria. The Level of Evidence was III or IV.Conclusions: There remains a paucity of high-level data. The mean incidence of CDEs was 28.8%. We found a strong positive correlation between CDEs and degree of elevation in the BCP (P = .056). Emerging evidence (Level IV) suggests that we may be able to stratify patients on the basis of age, history of hypertension and stroke, body mass index, diabetes mellitus, obstructive sleep apnea, and height. The challenge remains, however, in defining the degree and duration of cerebral desaturation, as measured by NIRS, required to produce measureable neurocognitive decline postoperatively.Level of Evidence: Level IV, systematic review of Level III and IV studies.",

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Pant, S, Bokor, DJ & Low, AK 2014, 'Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia', Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, vol. 30, no. 11, pp. 1520-1527. https://doi.org/10.1016/j.arthro.2014.05.042

Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. / Pant, Sushil; Bokor, Desmond J.; Low, Adrian K.

In: Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Vol. 30, No. 11, 01.11.2014, p. 1520-1527.

Research output: Contribution to journal › Review article › peer-review

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AU - Pant, Sushil

AU - Bokor, Desmond J.

AU - Low, Adrian K.

PY - 2014/11/1

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N2 - Purpose: To examine the risks of shoulder arthroscopy in the beach-chair position (BCP) as opposed to the lateral decubitus position. The challenge during general anesthesia, particularly with the patient in the BCP, has been to ascertain the lower limit of blood pressure autoregulation, correctly measure mean arterial pressure, and adequately adjust parameters to maintain cerebral perfusion. There is increasing concern about the BCP and its association with intraoperative cerebral desaturation events (CDEs). Assessment of CDEs intraoperatively remains difficult; the emerging technology near-infrared spectroscopy (NIRS) may provide noninvasive, inexpensive, and continuous assessment of cerebral perfusion, offering an "early warning" system before irreversible cerebral ischemia occurs.Methods: A systematic review was undertaken to determine the incidence of intraoperative CDEs as measured by NIRS and whether it is possible to risk stratify patients for intraoperative CDEs, specifically the degree of elevation in the BCP.Results: Searching Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 30, 2013, we found 9 studies (N = 339) that met our search criteria. The Level of Evidence was III or IV.Conclusions: There remains a paucity of high-level data. The mean incidence of CDEs was 28.8%. We found a strong positive correlation between CDEs and degree of elevation in the BCP (P = .056). Emerging evidence (Level IV) suggests that we may be able to stratify patients on the basis of age, history of hypertension and stroke, body mass index, diabetes mellitus, obstructive sleep apnea, and height. The challenge remains, however, in defining the degree and duration of cerebral desaturation, as measured by NIRS, required to produce measureable neurocognitive decline postoperatively.Level of Evidence: Level IV, systematic review of Level III and IV studies.

AB - Purpose: To examine the risks of shoulder arthroscopy in the beach-chair position (BCP) as opposed to the lateral decubitus position. The challenge during general anesthesia, particularly with the patient in the BCP, has been to ascertain the lower limit of blood pressure autoregulation, correctly measure mean arterial pressure, and adequately adjust parameters to maintain cerebral perfusion. There is increasing concern about the BCP and its association with intraoperative cerebral desaturation events (CDEs). Assessment of CDEs intraoperatively remains difficult; the emerging technology near-infrared spectroscopy (NIRS) may provide noninvasive, inexpensive, and continuous assessment of cerebral perfusion, offering an "early warning" system before irreversible cerebral ischemia occurs.Methods: A systematic review was undertaken to determine the incidence of intraoperative CDEs as measured by NIRS and whether it is possible to risk stratify patients for intraoperative CDEs, specifically the degree of elevation in the BCP.Results: Searching Medline, Embase, and the Cochrane Central Register of Controlled Trials from inception until December 30, 2013, we found 9 studies (N = 339) that met our search criteria. The Level of Evidence was III or IV.Conclusions: There remains a paucity of high-level data. The mean incidence of CDEs was 28.8%. We found a strong positive correlation between CDEs and degree of elevation in the BCP (P = .056). Emerging evidence (Level IV) suggests that we may be able to stratify patients on the basis of age, history of hypertension and stroke, body mass index, diabetes mellitus, obstructive sleep apnea, and height. The challenge remains, however, in defining the degree and duration of cerebral desaturation, as measured by NIRS, required to produce measureable neurocognitive decline postoperatively.Level of Evidence: Level IV, systematic review of Level III and IV studies.

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Pant S, Bokor DJ, Low AK. Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2014 Nov 1;30(11):1520-1527. https://doi.org/10.1016/j.arthro.2014.05.042

Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia

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