Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia
Acta Anaesthesiologica Scandinavica, 05/11/2012
Jeong H et al. – The incidence of jugular desaturation in beach chair position (BCP) was 41%, and P/R anaesthesia and hypotension were associated with its occurrence while undergoing surgery under general anaesthesia. SctO2 may not replace SjvO2 for the determination of cerebral oxygenation.
Fifty-six consecutive patients undergoing arthroscopic shoulder surgery in BCP were studied.
Anaesthesia was intravenous with propofol and remifentanil (P/R) or inhalational with sevoflurane and 50% nitrous oxide (S/N) depending on provider choice.
Mean arterial pressure (MAP), heart rate (HR), SjvO2, and SctO2 were measured before (baseline; post-induction in supine position) and after the patients assumed BCP.
Bland–Altman analysis was performed to measure the agreement between SctO2 and SjvO2.
SjvO2, SctO2, MAP, and HR decreased significantly when patients were raised into BCP.
Jugular desaturation occurred in 41% of patients (56% with P/R vs. 21% with S/N anaesthesia, P=0.0077).
Risk factors for the desaturation included P/R anaesthesia [adjusted odds ratio (aOR) 4.76, 95% confidence interval (CI) 1.34–16.95, P=0.016] and MAP<50mmHg (aOR 3.85, 95% CI 1.21–12.25, P=0.023).
Bland–Altman analysis showed a mean difference of -8.9% with 95% limit of agreement between -40.0% and 23.0%.
The percentage error [1.96 standard deviation/mean of the reference method] was 48.5%.
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