Beach Chair Position Anesthesia Complications

The beach chair position allows better surgical visualization compared to lateral decubitus position but may be associated with catastrophic neurologic complications including stroke spinal cord ischemia and transient visual loss. The question has been raised whether cerebral perfusion monitoring should be used routinely to minimize these potential complications.

Patient Positioning And Anaesthetic Consideration

The beach chair position BCP is extensively used as a routine approach for shoulder surgery in Australia New Zealand and around the world.

Beach chair position anesthesia complications. Beach-chair position and induced hypotension under general anesthesia has the potential to induce cerebral ischemia and increase related complications. Desaturation and the risk of neurologic injury associated with anesthesia and surgery in the beach chair position for shoulder surgery. 2 Lower limit of autoregulation likely much higher than 50mmHg and has wide inter- individual variability 3 Autoregulation is impaired in beach chair position 3 Correct for hydrostatic gradient.

Approximately two-thirds of the 400000 shoulder surgery procedures performed annually in the United States are performed with the patients head elevated above the horizontal a position know as the beach chair position BCP. Appropriate management of cerebral oxygenation is thus one of the primary goals of anesthetic management during such procedures. 1 2 This position affords better intra-articular visualization and less risk of neurovascular trauma than when patients are placed in the lateral decubitus.

This position is frequently used for shoulder arthroscopic surgery. 10262008 Its elimination from the anesthetic regimen at the time of dural closure has not been found to be efficacious. 1 Catastrophic neurological injury has occurred with BCP.

The mechanism of neurologic injury in the beach chair position. There are serious complications associated with the sitting position such as Venous Air Embolism VAE pneumocephalus quadriplegia and peripheral nerve injuries. Throughout the 2 hour and 20-minute operation his blood pressure was measured noninvasively by a cuff placed on his left arm varying from 13050 to 9055 mmHg.

Situations when general anesthesia is preferably avoided. To date experts are aware of at least 20 cases of paraplegia after acoustic neuroma resection in the sitting position. 112012 anesthesia and found significant reduc-tions in cerebral oxygenation in patients in the beach-chair position as opposed to the lateral decubitus position.

This can result in brain damage but an understanding of cerebral autoregulation is essential to prevent this occurrence. At our insti-tution we performed a small study with institutional review board approval com-paring mechanical ventilation to sponta-neous ventilation both general anesthesia. Those who made mistakes left the simulation following debriefing feeling that they would be able to appropriately manage this or a similar situation should it occur.

Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables. This simulation involves a 60-year-old man who became apneic in the beach-chair position following an interscalene block for rotator cuff repair. Since hypotension in beach chair position BCP can lead to catastrophic neurologic complications the prediction of hypotension is a matter of concern in the BCP under general anesthesia.

Although uncommon severe neurological events have been reported in patients undergoing shoulder surgery in the beach chair position. In patients who are anesthetized for surgery in the beach chair position brain blood pressure can fall to levels below the brains ability to autoregulate. Beach chair and sitting position.

Horse shoe head rest often used to support head using straps or tape to secure head to the headrest - note risk of brachial plexus injury with manipulation of limbshead. After induction of anesthesia he was placed in an upright 60 to 65 degree modified beach chair position. 1162019 Several published case reports and studies have raised concerns for neurologic complications related to anesthesia for surgery performed with patients in the beach chair position.

10312016 The majority of anesthesia residents who have participated in this simulation were able to properly address apnea in the beach-chair position following a brachial plexus block. Recent research has shown that cerebrovascular complications following shoulder surgery performed in the beach chair position under general anesthesia arise secondary to cerebral ischemia. FromtheDepartmentofAnesthesiologyandPainMedicineJHL KTM EJK SHC Anesthesia and Pain Research Institute JHLKTMSHCDepartmentofOrthopedicSurgeryY-MC.

Anesthesia residents should understand the complications of regional procedures and should know how to treat them if treatment is warranted. The sitting and beach chair position BCP are variations of nearly the same position with similar physiologic changes and potential complications. The presumed etiology of central nervous system injury is hypotension and subsequent cerebral hypoperfusion that occurs after alterations in positioning under general anesthesia.

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