Brazilian Journal of Anesthesiology
Brazilian Journal of Anesthesiology
Original Investigation

Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Huru Ceren Gokduman, Elif Aygun, Nur Canbolat, Mert Canbaz, Taner Abdullah, Ali Ersen, Mehmet I. Buget

Downloads: 0
Views: 20


Background and objectives
The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability.

This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10 of ideal body weight was administered intravenously 30 min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid.

The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p = 0.001, p = 0.016, p = 0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p = 0.016, p = 0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p = 0.003, p = 0.018, p = 0.019, respectively).

Consequently, preloading can be favorable approach to preserve hemodynamic stability.


Arthroscopic shoulder surgery;  Beach chair position;  Hemodynamic stability;  Postoperative nausea and vomiting;  Preloading


1 S.L. Larsen, T.S. Lyngeraa, C.P. Maschmann, J.J. Van Lieshout, F.C. Pott Cardiovascular consequence of reclining vs. sitting beach-chair body position for induction of anesthesia Front Physiol, 5 (2014), p. 187

2 A. Papadonikolakis, E.R. Wiesler, M.A. Olympio, G.G. Poehling Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position Arthroscopy, 24 (2008), pp. 481-482

3 I. Haršanji Drenjančević, D. Drenjančević, E. Davidović-Cvetko, I. Drenjančević, D. Gulam, S. Kvolik Does the anesthesia technique affect arterial pressure and regional cerebral oxygen saturation during shoulder arthroscopy in the beach chair position? Acta Clin Croat, 57 (2018), pp. 473-479

4 T.L. Trentman, S.L. Fassett, J.K. Thomas, B.N. Noble, K.J. Renfree, S.J. Hattrup More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position Can J Anaesth, 58 (2011), pp. 993-1000

5 D. Salazar, B.W. Sears, B. Aghdasi, et al. Cerebral desaturation events during shoulder arthroscopy in the beach chair position: patient risk factors and neurocognitive effects J Shoulder Elbow Surg, 22 (2013), pp. 1228-1235

6 M.G. Mythen, A.R. Webb Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery Arch Surg, 130 (1995), pp. 423-429

7 R.N. Cao, L. Tang, Z.Y. Xia, R. Xia Endothelial glycocalyx as a potential theriapeutic target in organ injuries Chin Med J (Engl), 132 (2019), pp. 963-975

8 D. Chappell, D. Bruegger, J. Potzel, et al. Hypervolemia increases release of atrial natriuretic peptide and shedding of the endothelial glycocalyx Crit Care, 18 (2014), p. 538

9 T.E. Woodcock, T.M. Woodcock Revised Starling equation and the glycocalyx model of transvascular fluid exchange: an improved paradigm for prescribing intravenous fluid therapy Br J Anaesth, 108 (2012), pp. 384-394

10 Y.Y. Jo, W.S. Jung, H.S. Kim, Y.J. Chang, H.J. Kwak Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables J Clin Monit Comput, 28 (2014), pp. 173-178

11 D.G. Dalrymple, S.W. MacGowan, G.F. MacLeod Cardiorespiratory effects of the sitting position in neurosurgery Br J Anaesth, 51 (1979), pp. 1079-1082

12 A Laflam, B Joshi, K Brady, et al. Shoulder surgery in the beach chair position is assocaited with diminished cerebral autoregulation but no difference in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study Anesth Analg, 120 (2015), pp. 176-185

13 A.E. Martynyuk, L.S. Ju, T.E. Morey, J.Q. Zhang Neuroendocrine, epigenetic, and intergenerational effects of general anesthetics World J Psychiatry, 10 (2020), pp. 81-94

14 H. Jeong, S.H. Lee, E.A. Jang, S.S. Chung, J. Lee, K.Y. Yoo Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia Acta Anaesthesiol Scand, 56 (2012), pp. 872-879

15 F. Salim, F. Khan, M. Nasir, R. Ali, A. Iqbal, A. Raza Frequency of intraoperative hypotension after the induction of anesthesia in hypertensive patients with preoperative angiotensin-converting enzyme inhibitors Cureus, 41 (2020), pp. 1-9

16 C. Hollmann, N.L. Fernandes, B.M. Biccard A systematic review of outcomes associated with withholding or continuing angiotensin-converting enzyme inhibitors and angiotensin receptor blockers before noncardiac surgery Anesth Analg, 127 (2018), pp. 678-687

17 J.J. Triplet, C.M. Lonetta, N.G. Everding, M.A. Moor, J.C. Levy Association between temporal mean arterial pressure and brachial noninvasive blood pressure during shoulder surgery in the beach chair position during general anesthesia J Shoulder Elb Surg, 24 (2015), pp. 127-132

18 S.H. Lee, Y.M. Chun, Y.J. Oh, et al. Prediction of fluid responsiveness in the beach chair position using dynamic preload indices J Clin Monitoring Computing, 30 (2016), pp. 995-1002

19 G. Marx, A.W. Schindler, C. Mosch, et al. Intravascular volume therapy in adults: Guidelines from the Association of the Scientific Medical Societies in Germany Eur J Anaesthesiol, 33 (2016), pp. 488-521

20 O. Hamzaoui, T.W.L. Scheeren, J.L. Teboul Norepinephrine in septic shock: when and how much? Curr Opin Crit Care, 23 (2017), pp. 342-347

21 F.J. Mercier Reply from the authors: 6% Hydroxyethyl starch (130/0.4) vs Ringer’s lactate preloading before spinal anaesthesia for Caesarean delivery Br J Anaesth, 115 (2015), pp. 328-329

22 W. Buhre, A. Weyland, K. Buhre, et al. Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures Br J Anaesth, 84 (2000), pp. 354-357

23 K. Frey, M. Rehm, D. Chappell, et al. Preemptive volume therapy to prevent hemodynamic changes caused by the beach chair position: hydroxyethyl starch 130/0.4 versus Ringer’s acetate-a controlled randomized trial J Shoulder Elbow Surg, 27 (2018), pp. 2129-2138

24 K. Holte, B. Klarskov, D.S. Christensen, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: A randomized, double-blind study Ann Surg, 240 (2004), pp. 892-899

25 J.J. Magner, C. McCaul, E. Carton, J. Gardiner, D. Buggy Effect of intraoperative intravenous crystalloid infusion on postoperative nausea and vomiting after gynaecological laparoscopy: comparison of 30 and 10 Br J Anaesth, 93 (2004), pp. 381-385

26 M. Ghafourifard, M. Zirak, M.H. Broojerdi, A. Bayendor, A. Moradi The effect of ringer versus haemaccel preload on incidence of postoperative nausea and vomiting J Caring Sci, 4 (2015), pp. 105-113

6154a60ea9539555745f1b63 rba Articles
Links & Downloads

Braz J Anesthesiol

Share this page
Page Sections