Added Level to Hemodynamic Monitoring
The beach chair position is commonly used during orthopedic shoulder surgery for better visualization and access to the operative site. However, elevating the patients head during procedures may lead to gravitational effects on cerebral perfusion.([FOOTNOTE=Laflam A, Joshi B, Brady K, Yenokyan G, Brown C, Everett A, Selnes O, McFarland E, Hogue CW. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. Anesth Analg. 2015 Jan; 120(1):176-85. Doi: 10.1213/ ANE.0000000000000455.],[ANCHOR=],[LINK=]), ([FOOTNOTE=Picton P et al. Influence of ventilation strategies and anesthetic techniques on regional cerebral oximetry in the beach chair position. Anesthesiology 2015. Oct; 123(4):765-74.],[ANCHOR=],[LINK=])
Maintaining adequate cerebral perfusion during surgery is imperative to preventing cerebral ischemia and other risks associated with cerebral desaturation. Several studies have cited that the occurrence of cerebral desaturation during shoulder surgery in the beach chair position suggests the need for perioperative cerebral perfusion monitoring.([FOOTNOTE=http://www2.snacc.org/aotm/aotm_feb2015.pdf],[ANCHOR=],[LINK=])
For patients in beach chair position, ventilation strategy positively influences cerebral perfusion regardless of anesthetic technique.12 Cerebral oximetry provides additional information along with noninvasive blood pressure and mean arterial pressure to provide a more accurate estimate of cerebral desaturation.
The INVOS™ system provides a continuous non-invasive measurement of cerebral oxygen saturation and a reliable indication of changes in cerebral perfusion. The INVOS™ system provides real-time monitoring of changes in regional oxygen saturation (rSO2) of blood in the brain or other body tissues beneath the sensor for effective oxygen monitoring in adults.([FOOTNOTE=http://www.medtronic.com/covidien/en-us/products/cerebral-somatic-oximetry],[ANCHOR=],[LINK=])