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  • Title: Middle cerebral artery blood flow velocity during beach chair position for shoulder surgery under general anesthesia.
    Author: Hanouz JL, Fiant AL, Gérard JL.
    Journal: J Clin Anesth; 2016 Sep; 33():31-6. PubMed ID: 27555129.
    Abstract:
    OBJECTIVES: The goal of the present study was to examine changes of middle cerebral artery (VMCA) blood flow velocity in patients scheduled for shoulder surgery in beach chair position. DESIGN: Prospective observational study. SETTING: Operating room, shoulder surgery. PATIENTS: Fifty-three consecutive patients scheduled for shoulder surgery in beach chair position. INTERVENTIONS: Transcranial Doppler performed after induction of general anesthesia (baseline), after beach chair positioning (BC1), during surgery 20minutes (BC2), and after back to supine position before stopping anesthesia (supine). MEASUREMENTS: Mean arterial pressure (MAP), end-tidal CO2, and volatile anesthetic concentration and VMCA were recorded at baseline, BC1, BC2, and supine. Postoperative neurologic complications were searched. MAIN RESULTS: Beach chair position induced decrease in MAP (baseline: 73±10mm Hg vs lower MAP recorded: 61±10mm Hg; P<.0001) requiring vasopressors and fluid challenge in 44 patients (83%). There was a significant decrease in VMCA after beach chair positioning (BC1: 33±10cm/s vs baseline: 39±14cm/s; P=.001). The VMCA at baseline (39±2cm/s), BC2 (35±14cm/s), and supine (39±14cm/s) were not different. The minimal alveolar concentration of volatile anesthetics, end-tidal CO2, SpO2, and MAP were not different at baseline, BC1, BC2, and supine. CONCLUSION: Beach chair position resulted in transient decrease in MAP requiring fluid challenge and vasopressors and a moderate decrease in VMCA.
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