Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position

Justin H. Chan*, Hector Perez, Harrison Lee, Matthew David Saltzman, Guido Marra

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. Methods: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%. Results: Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi–beach chair positioning. Patients experienced the largest oxygen saturation drop during semi–beach chair positioning. Transition from baseline to semi–beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi–beach chair interval (10%, P < .01) and the semi–beach chair to incision interval (7%, P < .01). Conclusions: Most patients experienced an intraoperative CDE, with greatest incidence during semi–beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi–beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.

Original languageEnglish (US)
JournalJournal of Shoulder and Elbow Surgery
DOIs
StatePublished - Jan 1 2019

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Arthroplasty
Perfusion
Oxygen
Nervous System Trauma
Oximetry
Near-Infrared Spectroscopy
Operative Time
Hypotension
Incidence

Keywords

  • Case Series
  • Level IV
  • Total shoulder arthroplasty
  • Treatment Study
  • beach chair position
  • cerebral oxygenation
  • near-infrared spectroscopy
  • semi–beach chair position

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{3376f3dc2d5f42be85f373cd33a5a739,
title = "Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position",
abstract = "Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. Methods: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20{\%}. Results: Nineteeen of 25 subjects experienced a CDE. 42{\%} of these patients experienced CDEs during semi–beach chair positioning. Patients experienced the largest oxygen saturation drop during semi–beach chair positioning. Transition from baseline to semi–beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8{\%}, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi–beach chair interval (10{\%}, P < .01) and the semi–beach chair to incision interval (7{\%}, P < .01). Conclusions: Most patients experienced an intraoperative CDE, with greatest incidence during semi–beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi–beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.",
keywords = "Case Series, Level IV, Total shoulder arthroplasty, Treatment Study, beach chair position, cerebral oxygenation, near-infrared spectroscopy, semi–beach chair position",
author = "Chan, {Justin H.} and Hector Perez and Harrison Lee and Saltzman, {Matthew David} and Guido Marra",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jse.2019.05.022",
language = "English (US)",
journal = "Journal of Shoulder and Elbow Surgery",
issn = "1058-2746",
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TY - JOUR

T1 - Evaluation of cerebral oxygen perfusion during shoulder arthroplasty performed in the semi–beach chair position

AU - Chan, Justin H.

AU - Perez, Hector

AU - Lee, Harrison

AU - Saltzman, Matthew David

AU - Marra, Guido

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. Methods: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%. Results: Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi–beach chair positioning. Patients experienced the largest oxygen saturation drop during semi–beach chair positioning. Transition from baseline to semi–beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi–beach chair interval (10%, P < .01) and the semi–beach chair to incision interval (7%, P < .01). Conclusions: Most patients experienced an intraoperative CDE, with greatest incidence during semi–beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi–beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.

AB - Background: The beach chair position is commonly used when performing shoulder arthroplasty. However, this position has been associated with hypotension, potentially leading to cerebral hypoperfusion, which may cause neurologic injury. In addition, shoulder arthroplasty cases are associated with longer operative times, posing a potentially greater risk of cerebral hypoperfusion. We aim to evaluate the risk of cerebral desaturation events (CDEs) during the course of total shoulder arthroplasty. Methods: Twenty-six patients undergoing shoulder arthroplasties were monitored for changes in cerebral perfusion. Seven specific time-points during the procedure were labeled for comparison of events: baseline, beach chair, incision, humeral broaching, glenoid reaming, glenoid component implantation, and humeral component implantation. Cerebral oxygen perfusion was measured using near-infrared spectroscopy. A CDE was described as a decrease of oxygen saturation greater than 20%. Results: Nineteeen of 25 subjects experienced a CDE. 42% of these patients experienced CDEs during semi–beach chair positioning. Patients experienced the largest oxygen saturation drop during semi–beach chair positioning. Transition from baseline to semi–beach chair was the only event to have a statistically significant decrease in cerebral perfusion (8%, P < .05). There was a statistically significant percentage change in mean oxygen saturation in the semi–beach chair interval (10%, P < .01) and the semi–beach chair to incision interval (7%, P < .01). Conclusions: Most patients experienced an intraoperative CDE, with greatest incidence during semi–beach chair positioning. The largest decline in cerebral oxygen saturation occurred during semi–beach chair positioning. Implant implantation was not associated with decrease in cerebral oximetry.

KW - Case Series

KW - Level IV

KW - Total shoulder arthroplasty

KW - Treatment Study

KW - beach chair position

KW - cerebral oxygenation

KW - near-infrared spectroscopy

KW - semi–beach chair position

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JF - Journal of Shoulder and Elbow Surgery

SN - 1058-2746

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