DOES THE ANESTHESIA TECHNIQUE AFFECT ARTERIAL PRESSURE AND REGIONAL CEREBRAL OXYGEN SATURATION DURING SHOULDER ARTHROSCOPY IN THE BEACH CHAIR POSITION?

Ivana Haršanji Drenjančević, Domagoj Drenjančević, Erna Davidović-Cvetko, Ines Drenjančević, Danijela Gulam, Slavica Kvolik, Ivana Haršanji Drenjančević, Domagoj Drenjančević, Erna Davidović-Cvetko, Ines Drenjančević, Danijela Gulam, Slavica Kvolik

Abstract

- This study aimed to investigate the impact of posture and anesthesia techniques on blood pressure changes, heart rate and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position (BCP). Sixty patients were included in this prospective cohort study: 30 patients mechanically ventilated and subjected to general anesthesia (GA) and 30 patients subjected to interscalene block (ISB) without mechanical ventilation. Noninvasive blood pressure, heart rate (HR), peripheral blood oxygen saturation and regional oxygen saturation of the brain were measured in twelve predefined points during perioperative period. The GA group patients had significantly lower mean arterial pressure and heart rate values compared to patients in ISB group during BCP (p<0.001). There was a significant difference in regional cerebral saturation between the groups measured only in points of induction and emergence from anesthesia in favor of GA group when receiving 100% oxygen (p<0.001). Changes in the mean arterial pressure and regional cerebral oxygen saturation for both brain hemispheres correlated only at the 10th minute after setting up BCP in GA patients (right, p=0.004 and left, p=0.003). This correlation did not exist in the ISB group patients at any of the points measured. Cerebral desaturation events recorded in both groups were not statistically significantly different. Results of this study demonstrated that GA preserved regional cerebral oxygenation in a safe range during BCP despite changes in the arterial blood pressure and heart rate in comparison to ISB.

Keywords: Anesthesia, general; Arterial pressure; Arthroscopy; Croatia; Hypoxia, brain; Posture; Spectroscopy, near-infrared.

Figures

Fig. 1
Fig. 1
Differences between two groups of patients undergoing shoulder arthroscopy in beach chair position (BCP): (A) depth of anesthesia as measured by BIS levels in patients in general anesthesia (GA) and in interscalene block (ISB); (B) differences in the mean arterial pressure (MAP) and heart rate values (HR); (C) cerebral oxygen saturation as measured by INVOS. Points of measurement in the premedication area: point 1 – lying down (supine); point 2 – in sitting position; point 3 – upon arrival in the operating room before positioning the patient in BCP; point 4 – immediately after BCP, during the operation; point 5 – five minutes after positioning; point 6 – ten minutes after positioning; point 7 – fifteen minutes after positioning; point 8 – twenty minutes after positioning; point 9 – twenty-five minutes after positioning; point 10 – lodging the patient at the end of the surgery; point 11 – thirty minutes after the end of the surgery; point 12 – sixty minutes after the end of the surgery. Data were presented as mean values and compared using 2-factor analysis of variance with repeated measures; *statistically significant differences between the groups (p

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