Prospective study to compare the difference in cerebral perfusion in patients undergoing shoulder surgery with the standard beach chair position compared to 30˚ inclination
Master Thesis
2016
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University of Cape Town
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There have been devastating reports of patients suffering permanent neurological damage following surgery in the beach chair position. Recent literature have shown that placing a patient under general anaesthesia in the beach chair position may place patients at risk of complications. There is no set angle of inclination used by all orthopaedic surgeons. Previous research have used angles of 70˚-90˚. At these angles patients suffered a significant number of cerebral desaturation events that may lead to ischaemic neurological events. This angle is far more upright than what is used in our practice. We postulated that decreasing the angle of inclination may be protective of cerebral perfusion. We performed a prospective randomised single blind study. 45 consecutive patients presenting for shoulder surgery were randomised to 2 groups. The control group patients were placed in the normal position used by the surgeon for the procedure and this angle was measured. The patients in the trial group were all placed at 30˚. Patients with known cerebrovascular disease, younger than 18 years, ASA grade 4 and 5, allergy to local anaesthetic, pre-existing coagulopathies or a failed interscalene block were excluded. Cerebral oxygenation were measured with the INVOS system along with the other standard observations in theatre. The 2 most important parameters measured were mean arterial pressure and cerebral oxygenation levels.
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Naude, P. 2016. Prospective study to compare the difference in cerebral perfusion in patients undergoing shoulder surgery with the standard beach chair position compared to 30˚ inclination. University of Cape Town.