Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia

Søren L Larsen, Tobias S Lyngeraa, Christian P Maschmann, Johannes J Van Lieshout, Frank C Pott, Søren L Larsen, Tobias S Lyngeraa, Christian P Maschmann, Johannes J Van Lieshout, Frank C Pott

Abstract

The sitting beach-chair position is regularly used for shoulder surgery and anesthesia may be induced in that position. We tested the hypothesis that the cardiovascular challenge induced by induction of anesthesia is attenuated if the patient is placed in a reclining beach-chair position. Anesthesia was induced with propofol in the sitting beach-chair (n = 15) or with the beach-chair tilted backwards to a reclining beach-chair position (n = 15). The last group was stepwise tilted to the sitting beach-chair position prior to surgery. Hypotension was treated with ephedrine. Continuous hemodynamic variables were recorded by photoplethysmography and frontal cerebral oxygenation (ScO2) by near infrared spectroscopy. Significant differences were only observed immediately after the induction when patients induced in a reclining beach-chair position had higher mean arterial pressure (MAP) (35 ± 12 vs. 45 ± 15 % reduction from baseline, p = 0.04) and ScO2 (7 ± 6 vs. 1 ± 8% increase from baseline, p = 0.02) and received less ephedrine (mean: 4 vs. 13 mg, p = 0.048). The higher blood pressure and lower need of vasopressor following induction of anesthesia in the reclining compared to the sitting beach-chair position indicate more stable hemodynamics with the clinical implication that anesthesia should not be induced with the patient in the sitting position.

Keywords: anesthesia; hemodynamics; near-infrared spectroscopy; patient positioning; shoulder.

Figures

Figure 1
Figure 1
Mean-values for all patients from 5 min prior to induction until 30 min after induction. Baseline was recorded in the sitting beach-chair position approximately 5 min prior to induction. During the 5 min prior to induction the patient was placed in the induction position (either sitting or reclining) with start of propofol and remifentanil infusions and preoxygenation. Instances of individual ephedrine-administrations are shown.

References

    1. Bogert L. W. J., Wesseling K. H., Schraa O., Van Lieshout E. J., De Mol B. A. J. M., Van Goudoever J., et al. (2010). Pulse contour cardiac output derived from non−invasive arterial pressure in cardiovascular disease. Anaesthesia 65, 1119–1125 10.1111/j.1365-2044.2010.06511.x
    1. Brassard P., Seifert T., Secher N. H. (2009). Is cerebral oxygenation negatively affected by infusion of norepinephrine in healthy subjects? Br. J. Anaesth. 102, 800–805 10.1093/bja/aep065
    1. Buhre W., Weyland A., Buhre K., Kazmaier S., Mursch K., Schmidt M., et al. (2000). Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br. J. Anaesth. 84, 354–357 10.1093/oxfordjournals.bja.a013439
    1. Casati A., Fanelli G., Pietropaoli P., Proietti R., Tufano R., Danelli G., et al. (2005). Continuous monitoring of cerebral oxygen saturation in elderly patients undergoing major abdominal surgery minimizes brain exposure to potential hypoxia. Anesth. Analg. 101, 740–747 10.1213/
    1. Dalrymple D. G., Macgowan S. W., Macleod G. F. (1979). Cardiorespiratory effects of the sitting position in neurosurgery. Br. J. Anaesth. 51, 1079–1082 10.1093/bja/51.11.1079
    1. Fischer G. W., Lin H.-M., Krol M., Galati M. F., Di Luozzo G., Griepp R. B., et al. (2011). Noninvasive cerebral oxygenation may predict outcome in patients undergoing aortic arch surgery. J. Thorac. Cardiovasc. Surg. 141, 815–821 10.1016/j.jtcvs.2010.05.017
    1. Hachiya T., Walsh M. L., Saito M., Blaber A. P. (2010). Delayed vasoconstrictor response to venous pooling in the calf is associated with high orthostatic tolerance to LBNP. J. Appl. Physiol. 109, 996–1001 10.1152/japplphysiol.00593.2009
    1. Højlund J., Sandmand M., Sonne M., Mantoni T., Jørgensen H. L., Belhage B., et al. (2012). Effect of head rotation on cerebral blood velocity in the prone position. Anesthesiol. Res. Pract. 2012, 647258 10.1155/2012/647258
    1. Jeong H., Jeong S., Lim H. J., Lee J., Yoo K. Y. (2012). Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology 116, 1047–1056 10.1097/ALN.0b013e31825154d2
    1. Joshi B., Ono M., Brown C., Brady K., Easley R. B., Yenokyan G., et al. (2012). Predicting the limits of cerebral autoregulation during cardiopulmonary bypass. Anesth. Analg. 114, 503–510 10.1213/ANE.0b013e31823d292a
    1. Kim Y.-S., Davis S. C. A. T., Truijen J., Stok W. J., Secher N. H., van Lieshout J. J. (2011). Intensive blood pressure control affects cerebral blood flow in type 2 diabetes mellitus patients. Hypertension 57, 738–745 10.1161/HYPERTENSIONAHA.110.160523
    1. Kinsella S. M., Tuckey J. P. (2001). Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold–Jarisch reflex. Br. J. Anaesth. 86, 859–868 10.1093/bja/86.6.859
    1. Koyama S., Sato N., Nagashima K., Aizawa H., Kawamura Y., Hasebe N., et al. (2002). Effects of right stellate ganglion block on the autonomic nervous function of the heart: a study using the head-up tilt test. Circ. J. 66, 645–648 10.1253/circj.66.645
    1. Kwak H. J., Lee J. S., Lee D. C., Kim H. S., Kim J. Y. (2010). The effect of a sequential compression device on hemodynamics in arthroscopic shoulder surgery using beach-chair position. Arthrosc. J. Arthrosc. Relat. Surg. 26, 729–733 10.1016/j.arthro.2009.10.001
    1. Lee J. H., Min K. T., Chun Y.-M., Kim E. J., Choi S. H. (2011). Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery. Arthroscopy 27, 889–894 10.1016/j.arthro.2011.02.027
    1. Martina J. R., Westerhof B. E., van Goudoever J., de Beaumont E. M. F. H., Truijen J., Kim Y.-S., et al. (2012). Noninvasive continuous arterial blood pressure monitoring with Nexfin®. Anesthesiology 116, 1092–1103 10.1097/ALN.0b013e31824f94ed
    1. McCulloch T. J., Liyanagama K., Petchell J. (2010). Relative hypotension in the beach-chair position: effects on middle cerebral artery blood velocity. Anaesth. Intensive Care 38, 486–491
    1. Moerman A. T., De Hert S. G., Jacobs T. F., De Wilde L. F., Wouters P. F. (2012). Cerebral oxygen desaturation during beach chair position. Eur. J. Anaesthesiol. 29, 82–87 10.1097/EJA.0b013e328348ca18
    1. Moritz S., Kasprzak P., Arlt M., Taeger K., Metz C. (2007). Accuracy of cerebral monitoring in detecting cerebral ischemia during carotid endarterectomy. Anesthesiology 107, 563–569 10.1097/01.anes.0000281894.69422.ff
    1. Nissen P., Brassard P., Jørgensen T. B., Secher N. H. (2009). Phenylephrine but not ephedrine reduces frontal lobe oxygenation following anesthesia-induced hypotension. Neurocrit. Care 12, 17–23 10.1007/s12028-009-9313-x
    1. Ogoh S., Sato K., Okazaki K., Miyamoto T., Secher F., Sorensen H., et al. (2014). A decrease in spatially resolved near-infrared spectroscopy-determined frontal lobe tissue oxygenation by phenylephrine reflects reduced skin blood flow. Anesth. Analg. 118, 823–829 10.1213/ANE.0000000000000145
    1. Ono M., Arnaoutakis G. J., Fine D. M., Brady K., Easley R. B., Zheng Y., et al. (2013). Blood pressure excursions below the cerebral autoregulation threshold during cardiac surgery are associated with acute kidney injury. Crit. Care Med. 41, 464–471 10.1097/CCM.0b013e31826ab3a1
    1. Papadonikolakis A., Wiesler E. R., Olympio M. A., Poehling G. G. (2008). Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position. Arthroscopy 24, 481–482 10.1016/j.arthro.2008.02.005
    1. Peruto C. M., Ciccotti M. G., Cohen S. B. (2009). Shoulder arthroscopy positioning: lateral decubitus versus beach chair. Arthroscopy 25, 891–896 10.1016/j.arthro.2008.10.003
    1. Pin-On P., Schroeder D., Munis J. (2013). The hemodynamic management of 5177 neurosurgical and orthopedic patients who underwent surgery in the sitting or “beach chair” position without incidence of adverse neurologic events. Anesth. Analg. 116, 1317–1324 10.1213/ANE.0b013e31828446bb
    1. Pohl A., Cullen D. J. (2005). Cerebral ischemia during shoulder surgery in the upright position: a case series. J. Clin. Anesth. 17, 463–469 10.1016/j.jclinane.2004.09.012
    1. Porter J. M., Pidgeon C., Cunningham A. J. (1999). The sitting position in neurosurgery: a critical appraisal. Br. J. Anaesth. 82, 117–128 10.1093/bja/82.1.117
    1. Rains D. D., Rooke G. A., Wahl C. J. (2011). Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy 27, 532–541 10.1016/j.arthro.2010.09.008
    1. Skyhar M. J., Altchek D. W., Warren R. F., Wickiewicz T. L., O'Brien S. J. (1988). Shoulder arthroscopy with the patient in the beach-chair position. Arthroscopy 4, 256–259
    1. Smith M., Elwell C. (2009). Near-infrared spectroscopy: Shedding light on the injured brain. Anesth. Analg. 108, 1055–1057 10.1213/ane.0b013e31819a0301
    1. Song S. Y., Roh W. S. (2012). Hypotensive bradycardic events during shoulder arthroscopic surgery under interscalene brachial plexus blocks. Korean J. Anesthesiol. 62, 209–219 10.4097/kjae.2012.62.3.209
    1. Sørensen H. M. S., Secher N. H. M. D., Siebenmann C. M. S., Nielsen H. B. M. D., Kohl-Bareis M. P. D., Lundby C. P. D., et al. (2012). Cutaneous vasoconstriction affects near-infrared spectroscopy determined cerebral oxygen saturation during administration of norepinephrine. Anesthesiology 117, 263–270 10.1097/ALN.0b013e3182605afe
    1. Sørensen H., Rasmussen P., Sato K., Persson S., Olesen N. D., Nielsen H. B., et al. (2014). External carotid artery flow maintains near infrared spectroscopy-determined frontal lobe oxygenation during ephedrine administration. Br. J. Anaesth. [Epub ahead of print]. 10.1093/bja/aet481
    1. Tange K., Kinoshita H., Minonishi T., Hatakeyama N., Matsuda N., Yamazaki M., et al. (2010). Cerebral oxygenation in the beach chair position before and during general anesthesia. Minerva Anestesiol. 76, 485–490
    1. Truijen J., Kim Y. S., Krediet C. T. P., Stok W. J., Kölgen R. S., Colier W. N., et al. (2012). Orthostatic leg blood volume changes assessed by near-infrared spectroscopy. Exp. Physiol. 97, 353–361 10.1113/expphysiol.2011.061051
    1. Van der Spoel A. G. E., Voogel A. J., Folkers A., Boer C., Bouwman R. A. (2012). Comparison of noninvasive continuous arterial waveform analysis (Nexfin) with transthoracic Doppler echocardiography for monitoring of cardiac output. J. Clin. Anesth. 24, 304–309 10.1016/j.jclinane.2011.09.008
    1. Van Geldorp I. E., Delhaas T., Hermans B., Vernooy K., Broers B., Klimusina J., et al. (2011). Comparison of a non-invasive arterial pulse contour technique and echo Doppler aorta velocity-time integral on stroke volume changes in optimization of cardiac resynchronization therapy. Europace 13, 87–95 10.1093/europace/euq348

Source: PubMed

Sponsors en medewerkers

Medische omstandigheden

Geneesmiddelinterventies

3
Abonneren