Neurocognitive Deficits and Cerebral Desaturation During Shoulder Arthroscopy With Patient in Beach-Chair Position: A Review of the Current Literature

Arthroscopic shoulder surgery with the patient in the beach-chair position (BCP) has been associated with neurocognitive complications caused by cerebral ischemia. We reviewed the current literature for the incidence of postoperative neurocognitive deficits, number of reported neurocognitive complications, and incidence of intraoperative cerebral desaturation events in patients who underwent arthroscopic shoulder surgery in the BCP. Among 10 studies with a composite enrollment of 24,701 patients, there was only 1 case of a postoperative neurocognitive deficit (overall incidence, 0.004%). Four case reports (not included in the 10 studies) described 6 patients with a catastrophic neurocognitive complication after shoulder surgery in the BCP. Incidence of reported intraoperative cerebral desaturation events varied significantly (0%-100%; mean, 41.1%). Neurocognitive complications have been reported in patients who had arthroscopic shoulder surgery in the BCP. Intraoperative monitoring of cerebral perfusion, alternatives to general anesthesia, and prudent use of intraoperative blood pressure control may improve patient safety.