Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

• Published in: Clinical orthopaedics and related research 2013-12, Vol.471 (12), p.4027-4034
• Main Authors: Salazar, Dane, Sears, Benjamin W., Andre, John, Tonino, Pietro, Marra, Guido
• Format: Article
• Language: English
• Subjects: Adult; Aged; Arthroscopy - adverse effects; Arthroscopy - methods; Beaches; Brain Ischemia - etiology; Clinical Research; Cognition Disorders - etiology; Conservative Orthopedics; Female; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Oximetry; Patient Positioning; Posture; Prospective Studies; Shoulder; Shoulder Joint - surgery; Sports Medicine; Surgery; Surgical Orthopedics
• ISSN: 0009-921X; 1528-1132
• DOI: 10.1007/s11999-013-2987-6

Background Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia. Questions/purposes We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs. Methods Regional cerebral tissue oxygen saturation (rSO 2 ) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO 2 of 20% or greater were defined as CDEs. Results The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO 2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes). Conclusions The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.