Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: A randomized controlled trial

G. S. Murphy*, J. W. Szokol, M. J. Avram, S. B. Greenberg, T. D. Shear, J. S. Vender, S. D. Levin, J. L. Koh, K. N. Parikh, S. S. Patel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Background. Surgery in the beach chair position (BCP) may reduce cerebral blood flow and oxygenation, resulting in neurological injuries. The authors tested the hypothesis that a ventilation strategy designed to achieve end-tidal carbon dioxide (E′CO2 ) values of 40.42 mm Hg would increase cerebral oxygenation (SctO2 ) during BCP shoulder surgery compared with a ventilation strategy designed to achieve E′CO2 values of 30.32 mm Hg. Methods. Seventy patients undergoing shoulder surgery in the BCP with general anaesthesia were enrolled in this randomized controlled trial. Mechanical ventilation was adjusted to maintain an E′CO2 of 30.32 mm Hg in the control group and an E′CO2 of 40.42 mm Hg in the study group. Cerebral oxygenation was monitored continuously in the operating theatre using near-infrared spectroscopy. Baseline haemodynamics and SctO2 were obtained before induction of anaesthesia, and these values were then measured and recorded continuously from induction of anaesthesia until tracheal extubation. The number of cerebral desaturation events (CDEs) (defined as a ≥20% reduction in SctO2 frombaseline values) was recorded. Results. No significant differences between the groups were observed in haemodynamic variables or phenylephrine interventions during the surgical procedure. SctO2 values were significantly higher in the study 40.42 group throughout the intraoperative period (P,0.01). In addition, the incidence of CDEs was lower in the study 40.42 group (8.8%) compared with the control 30.32 group (55.6%, P,0.0001). Conclusions. Cerebral oxygenation is significantly improved during BCP surgerywhen ventilation is adjusted tomaintain E′CO2 at 40.42mmHg compared with 30.32mmHg. Clinical trial registration. ClinicalTrials.gov NCT01546636.

Original languageEnglish (US)
Pages (from-to)618-627
Number of pages10
JournalBritish journal of anaesthesia
Issue number4
StatePublished - Oct 1 2014


  • Patient positioning
  • Spectroscopy, near-infrared
  • Ventilation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


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