Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2015.02.002
Brazilian Journal of Anesthesiology
Scientific Article

Patient state index and cerebral blood flow changes during shoulder arthroscopy in beach chair position

Patient State Index e alterações do fluxo sanguíneo cerebral durante artroscopia do ombro em posição de cadeira de praia

Mehmet Ilke Buget; Ata Can Atalar; Ipek Saadet Edipoglu; Zerrin Sungur; Nukhet Sivrikoz; Meltem Karadeniz; Esra Saka; Suleyman Kucukay; Mert N. Senturk

http://dx.doi.org/10.1016/j.bjane.2015.02.002 Braz J Anesthesiol, vol.66, n5, p.470-474, 2016
PDF English
PDF Português
Downloads: 0
Views: 647

Abstract

Abstract Background and objectives: The aim of the study were to demonstrate the possible hemodynamic changes and cerebral blood flow alterations in patients who were positioned from supine to beach chair position; and to detect if the position change causes any cortical activity alteration as measured by the 4-channeled electroencephalography monitor. Methods: 35 patients were included. Before the induction, mean arterial pressure and patient state index values were recorded (T0). After the intubation, doppler-ultrasonography of the patients’ internal carotid and vertebral arteries were evaluated to acquire cerebral blood flow values from the formula. In supine position, mean arterial pressure, patient state index and cerebral blood flow values were recorded (T1) and the patient was positioned to beach chair position. After 5 min all measurements were repeated (T2). Measurements of patient state index and mean arterial pressure were repeated after 20 (T3), and 40 (T4) min. Results: There was a significant decrease between T0 and T1 in heart rate (80.5 ± 11.6 vs. 75.9 ± 14.4 beats/min), MAP (105.8 ± 21.9 vs. 78.9 ± 18.4 mmHg) and PSI (88.5 ± 8.3 vs. 30.3 ± 9.7) (all p < 0.05). Mean arterial pressure decreased significantly after position change, and remained decreased, compared to T1. The overall analysis of patient state index values (T1-T4) showed no significant change; however, comparing only T1 and T2 resulted in a statically significant decrease in patient state index. There was a significant decrease in cerebral blood flow after beach chair position. Conclusion: Beach chair position was associated with a decrease in cerebral blood flow and patient state index values. Patient state index was affected by the gravitational change of the cerebral blood flow; however, both factors were not directly correlated to each other. Moreover, the decrease in patient state index value was transient and returned to normal values within 20 min.

Keywords

Patient state index, Cerebral, Cerebral blood flow, Beach chair position

Resumo

Resumo Justificativa e objetivos: Demonstrar as possíveis alterações hemodinâmicas e do fluxo sanguíneo cerebral (FSC) em pacientes que foram posicionados de supinação para cadeira de praia (CP) e detectar se a mudança de posição causa alguma alteração na atividade cortical como mensurado pelo monitor de EEG com quatro canais. Métodos: Foram incluídos 35 pacientes. Antes da indução, os valores da PAM e do IEP foram registrados (T0). Após a intubação, ultrassonografias com Doppler da carótida interna e artérias vertebrais dos pacientes foram avaliadas para adquirir os valores do FSC a partir da fórmula. Em supinação, os valores da PAM, IEP e FSC foram registrados (T1) e o paciente foi posicionado em CP. Após cinco minutos, todas as mensurações foram repetidas (T2). As mensurações do IEP e PAM foram repetidas após 20 (T3) e 40 minutos (T4). Resultados: Houve uma diminuição significativa entre T0 e T1 na FC (80,5 ± 11,6 vs. 75,9 ± 14,4 bpm), PAM (105,8 ± 21,9 vs. 78,9 ± 18,4 mmHg) e IEP (88,5 ± 8,3 vs. 30,3 ± 9,7) (p < 0,05 para todos). A PAM diminuiu significativamente após a mudança de posição e permaneceu diminuída em relação a T1. A análise global dos valores do IEP (T1-T4) não mostrou mudança significativa, mas a comparação de apenas T1 e T2 resultou em redução estatisticamente significativa do IEP. Houve redução significativa do FSC após o posicionado em CP. Conclusão: O posicionado em CP foi associado à diminuição do FSC e dos valores do IEP. O IEP foi afetado pela mudança gravitacional do FSC; no entanto, ambos os fatores não estavam diretamente correlacionados. Além disso, a diminuição do valor do IEP foi transitória e voltou aos valores normais dentro de 20 minutos.

Palavras-chave

Patient State Index, Cerebral, Fluxo sanguíneo cerebral, Posição de cadeira de praia

References

Jeong H, Jeong S, Lim HJ. Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology. 2012;116:1047-56.

Provencher MT, Solomon DJ, Gaston TM, David TS, Andrews JR. Positioning for shoulder arthroscopy beach chair and lateral decubitus. 2008:1-14.

Koh JL, Levin SD, Chehab EL. Neer Award 2012: cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation. J Shoulder Elbow Surg. 2013;22:1325-31.

Buhre W, Weyland A, Buhre K. Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth. 2000;84:354-7.

Chen X, Tang J, White PF. A comparison of patient state index and bispectral index values during the perioperative period. Anesth Analg. 2002;95:1669-74.

Drover DR, Lemmens HJ, Pierce ET. Patient state index titration of delivery and recovery from propofol, alfentanil, and nitrousoxide anesthesia. Anesthesiology. 2002;97:82-9.

John ER, Prichep LS, Friedman J. Neurometrics: computer assisted differential diagnosis of brain dysfunctions. Science. 1988;239:162-9.

Chabot RJ, Gugino LD, Aglio LS. QEEG and neuropsychological profiles of patients after cardiopulmonary bypass surgical procedures. Clin EEG. 1997;28:98-105.

White PF, Tang J, Ma H. Is the patient state analyzer with the PSArray2 a cost-effective alternative to the bispectral index monitor during the perioperative period?. Anesth Analg. 2004;99:1429-35.

Cavus E, Meybohm P, Doerges V. Effects of cerebral hypoperfusion on bispectral index: a randomised, controlled animal experiment during haemorrhagic shock. Resuscitation. 2010;81:1183-9.

Lauwick S, English M, Hemmerling TM. An unusual case of cerebral hypoperfusion detected by bispectral index monitoring. Can J Anaesth. 2007;54:680-1.

Morimoto Y, Monden Y, Ohtake K. The detection cerebral hypoperfusion with bispectral index monitoring during general anesthesia. Anesth Analg. 2005;100:158-61.

Lee SW, Choi SE, Han JH. Effect of beach chair position on bispectral index values during arthroscopic shoulder surgery. Korean J Anesthesiol. 2014;67:235-9.

Soeding PF, Wang J, Hoy G. The effect of the sitting upright or ‘beachchair’ position on cerebral blood flow during anaesthesia for shoulder surgery. Anaesth Intensive Care. 2011;39:440-8.

McCulloch TJ, Liyanagama K, Petchell J. Relative hypotension in the beach-chair position: effects on middle cerebral artery blood velocity. Anaesth Intensive Care. 2010;38:486-91.

Nguyen NK, Lenkovsky F, Joshi GP. Patient state index during a cardiac arrest in the operating room. Anesth Analg. 2005;100:155-7.

Jiang Y, Qiao B, Wu L. Application of Narcotrend™ monitor for evaluation of depth of anesthesia in infants undergoing cardiac surgery: a prospective control study. Rev Bras Anestesiol. 2013;63:273-8.

Springman SR, Andrei AC, Willmann K. A comparison of SNAP II and bispectral index monitoring in patients undergoing sedation. Anaesthesia. 2010;65:815-9.

Soehle M, Kuech M, Grube M. Patient state index vs. bispectral index as measures of the electroencephalographic effects of propofol. Br J Anaesth. 2010;105:172-8.

Kawanishi S, Hamanami K, Takahashi T. Impact of beach chair position on the value of bispectral index during general anesthesia. Masui. 2012;61:820-5.

Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth. 2005;17:463-9.

Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. Anesth Analg. 2003;96:899-902.

5dcd66c20e8825625abf58f1 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections