Controlled hypotensive anesthesia in the beach-chair position under general anesthesia: Is it safe for shoulder arthroscopy?
Journal Title: Gulhane Medical Journal - Year 2020, Vol 62, Issue 2
Abstract
Aims: The beach-chair position (BCP) imposes a risk to cerebrovascular hypoperfusion due to deep hypotensive events (DHEs) which may progress to catastrophic neurological complications. However, a controlled hypotensive anesthesia (CHA) management is often required for arthroscopic shoulder surgery to reduce blood loss and to improve visibility of surgical field. The aim of this retrospective study was to evaluate CHA managements, DHEs, and complications in patients who underwent shoulder arthroscopy in the BCP under general anesthesia (GA) between years 2017 and 2019. Methods: After hospital’s ethic committee approval was obtained, medical records of 72 adult patients were retrospectively reviewed. Primary outcome measures were the frequency of CHA management and the incidence of DHE. Secondary outcome measures were to determine the stages of surgery at which DHEs have developed and the complications. Results: CHA was required in 46 of total 72 patients (63.9%). Among those 46 patients, 31 (67.4%) had at least one DHE. A total of 82 DHEs were detected in 49 patients whereas mean arterial pressure limits were normal (±30% of baseline) in the remaining 23 (68.1% vs. 31.9%; p<0.05). DHEs were recorded most frequently after BCP (p<0.05). All DHEs were promptly treated with the discontinuation of CHA and administration of vasopressor drugs. No neurological complication was observed. Conclusions: GA in BCP caused DHEs and its incidence was increased by inducing CHA. It was concluded that neurological complications could be prevented when further decrease in blood pressure was avoided or promptly treated in case of a hypotensive event.
Authors and Affiliations
Mehmet Özgür Özhan, Mehmet Burak Eşkin, Ceyda Çaparlar, Mehmet Anıl Süzer, Uğur Gönç, Bülent Atik, Metin Polat
Keywords
Related Articles
- EP ID EP684405
- DOI 10.4274/gulhane.galenos.2020.924
- Views 153
- Downloads 0
Electrophysiological assessment in spinal intradural tumors
Aims: To present our spinal intradural tumor series and to evaluate the reliability of electrophysiological assessment in patients treated for these tumors. Methods: We retrospectively evaluated the data of patients tre...
The awareness of chronic obstructive pulmonary disease among smokers admitting to pulmonary medicine outpatient clinic: Single center experience
Aims: Smoking is the strongest risk factor for chronic obstructive pulmonary disease (COPD), but the awareness of COPD among smokers has been found at low levels worldwide. The aim of current study was to assess the COPD...
Is mitral balloon valvuloplasty really innocent?: A case report of right ventricular rupture
Percutaneous mitral balloon valvuloplasty (PMBV) is the primary treatment modality in patients with mitral stenosis without contraindications and with appropriate valve anatomy. In the literature, the mortality rate asso...
Vasomotor reactivity in the ophthalmic artery
Aim: The aim of this study was to obtain information about reactivity differences in ophthalmic artery (OA) and middle cerebral artery (MCA) presented as a change in blood flow velocity (BFV) induced by the breath holdin...
Evaluation of risk factors and causative pathogens in bloodstream infections in cancer patients
Aims: Bloodstream infection in cancer patients may cause delays in chemotherapy, prolonged hospital stay, difficulties in diagnosis and treatment, inappropriate treatment, high mortality rates and increased health care c...