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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2022; 09(01): 016-020
DOI: 10.1055/s-0041-1732830
Original Article

Effect of Beach-Chair Position on Cerebral Blood Flow in Patients Undergoing Shoulder Surgery—A Preliminary Observational Study

Jesudoss Antony
1   Department of Anaesthesia, Christian Medical College, Vellore, India
,
Georgene Singh
2   Department of Neuroanaesthesia, Christian Medical College, Vellore, India
,
Bijesh Yadav
3   Department of Biostatistics, Christian Medical College, Vellore, India
,
Melvin A. Abraham
4   Anaesthesia and Intensive Care Medicine, Maidstone and Tunbridge Wells NHS Trust, United Kingdom
,
Sajan P. George
1   Department of Anaesthesia, Christian Medical College, Vellore, India
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Abstract

Background Hypotension and cerebral hypoperfusion, commonly encountered in beach-chair position under general anesthesia, carry the risk of neurologic complications. There is a paucity of data on monitoring cerebral perfusion. Our objective was to compare the mean arterial pressure (MAP) and middle cerebral artery velocity (Vmca) in the supine and beach-chair position and estimate its correlation during hypotension.

Materials and Methods Twenty ASA class I and II patients undergoing elective shoulder surgery in beach-chair position were included in the study. MAP was measured invasively with the pressure transducer leveled to the phlebostatic axis. Vmca was measured with a 2 MHz transcranial Doppler (TCD) probe through the temporal window. Both MAP and Vmca were measured at baseline after anesthetic induction in the supine position (BL), on assuming the beach-chair position (AP), at steady-state hemodynamics in beach-chair position (P1), whenever there was a drop in MAP > 20% (P2), and on the restoration of MAP (P3).

Results A mean decrease in MAP and Vmca by 24.76% and 27.96%, respectively, from supine to beach-chair position with a significant linear correlation between MAP and Vmca along with a Pearsons' coefficient of 0.77 was seen. A change in MAP of 1 mm of Hg resulted in a change in Vmca by 0.53 cm/sec (p < 0.05).

Conclusion A significant decrease in MAP and Vmca was observed in the beach-chair position. TCD could be used as a point-of-care noninvasive technique to reliably assess cerebral perfusion.

Keywords

cerebral blood flow velocity - beach chair position - transcranial doppler


Publication History

Article published online:
24 October 2021

© 2021. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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