Vasopressin ameliorates hypotension induced by beach chair positioning in a dose-dependent manner in patients undergoing arthroscopic shoulder surgery under general anesthesia
نویسندگان
چکیده
BACKGROUND The beach chair position (BCP) is associated with hypotension that may lead to cerebral ischemia. Arginine vasopressin (AVP), a potent vasoconstrictor, has been shown to prevent hypotension in BCP. It also improves cerebral oxygenation in different animal models. The present study examined the effect of escalating doses of AVP on systemic hemodynamics and cerebral oxygenation during surgery in BCP under general anesthesia. METHODS Sixty patients undergoing arthroscopic shoulder surgery in BCP under general anesthesia were randomly allocated to receive either saline (control, n = 15) or three different doses of AVP (0.025, 0.05, or 0.075 U/kg; n = 15 each) 2 minutes before BCP. Mean arterial pressure (MAP), heart rate (HR), regional cerebral oxygen saturation (SctO2), and jugular venous oxygen saturation (SjvO2) were measured after induction of anesthesia and before (presitting in supine position) and after BCP. RESULTS AVP per se given before BCP increased MAP, and decreased SjvO2, SctO2, and HR in all patients (P < 0.05 for all). BCP decreased MAP, the magnitude of which and hence the incidence of hypotension was decreased by AVP in a dose-dependent manner. While in BCP, every dose of AVP reduced the HR and SctO2. Accordingly, it increased the incidence of cerebral desaturation (> 20% SctO2 decrease from the baseline value) with no differences in SjvO2 and the incidence of SjvO2 < 50% or SjvO2 < 40% among the groups. CONCLUSIONS AVP ameliorates hypotension associated with BCP in a dose-dependent manner in patients undergoing shoulder surgery under general anesthesia. However, AVP may have negative effects on SctO2 before and after BCP and on SjvO2 before BCP.
منابع مشابه
Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery.
PURPOSE We investigated the effects of the beach-chair position and induced hypotension on regional cerebral oxygen saturation (rSO(2)) in patients undergoing arthroscopic shoulder surgery by using near-infrared spectroscopy. METHODS Twenty-eight patients scheduled for arthroscopic shoulder surgery were enrolled prospectively. After induction of anesthesia, mechanical ventilation was controll...
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BACKGROUND Bispectral index (BIS) monitoring reduces the cases of intraoperative awareness. Several factors can alter BIS readings without affecting the depth of anesthesia. We conducted a study to assess the impact of beach chair position (sitting position) on BIS readings. METHODS General anesthesia was administered to 30 patients undergoing arthroscopic shoulder surgery. Patients were kept...
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Recent research has shown that cerebrovascular complications following shoulder surgery performed in the beach chair position under general anesthesia arise secondary to cerebral ischemia. Appropriate management of cerebral oxygenation is thus one of the primary goals of anesthetic management during such procedures. The present report describes the case of a 65-year-old male patient, in which b...
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Arthroscopic shoulder surgery is a common procedure and can be performed with the patient in the lateral decubitus position (LDP) or beach chair position (BCP). Although the BCP is associated with better visualization and less bleeding, it has also been associated with hemodynamic changes and consequently cerebral hypoperfusion. Devastating events reported after surgery in the BCP were attribut...
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عنوان ژورنال:
دوره 68 شماره
صفحات -
تاریخ انتشار 2015