Prophylactic measures to prevent cerebral oxygen desaturation events in elective beach-chair position shoulder surgeries; a systematic review and meta-analysis

Tantry Thrivikrama P; BG Muralishankar; Karanth Harish; Shetty Pramal K; Shenoy Sunil P; Kadam Dinesh; Tantry Gururraj; Shetty Rithesh

doi:10.4097/kja.21069

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자료유형: 학술저널

저자정보: Tantry Thrivikrama P (A J Institute of Medical Sciences & Research Center) BG Muralishankar (A J Institute of Medical Sciences & Research Center) Karanth Harish (A J Institute of Medical Sciences & Research Center) Shetty Pramal K (A J Institute of Medical Sciences & Research Center) Shenoy Sunil P (A J Institute of Medical Sciences & Research Center) Kadam Dinesh (A J Institute of Medical Sciences & Research Center) Tantry Gururraj (A J Institute of Medical Sciences & Research Center) Shetty Rithesh (A J Institute of Medical Sciences & Research Center)

저널정보: 대한마취통증의학회(구 대한마취과학회) Korean Journal of Anesthesiology Korean Journal of Anesthesiology Vol.74 No.5

발행연도: 2021.10

수록면: 422 - 438 (17page)

DOI: 10.4097/kja.21069

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Background: Prophylaxis for cerebral desaturation events (CDEs) during anesthesia in the beach chair position (BCP) for shoulder surgeries has not been evaluated. We systematically analyzed the effectiveness of various prophylactic measures used in this clinical setting. Methods: We performed a meta-analysis (PROSPERO; no. CRD42020167285) of trials reporting CDEs and regional cerebral oxygen saturation (rSO2) and jugular venous oxygen saturation (SjvO2) values in anesthetized patients undergoing shoulder surgery in BCP. Considering the type of prophylactic measures used (pharmacological or non-pharmacological), a subgroup analysis was planned. Outcomes included (1) rSO2 and SjvO2 data with and without prophylactic measures for CDEs, recorded for different time intervals, and (2) the number of patients experiencing CDEs and hypotension. Results: Twelve studies (786 patients) were included in the analysis. We observed lower absolute rSO2 values for early and all-time periods for vasoactive agent prophylaxis. The lowest achieved rSO2 values were also lower for vasoactive agent prophylaxis. Risk of CDEs was higher with vasoactive agent prophylaxis. Subgroup analysis identified targeted mild hypercarbia as effective in preserving cerebral oxygenation. Similarly, targeted mild hypercarbia prevented the fall in rSO2 with position change. Meta-regressions revealed statistically significant highest estimates for vasoactive agent prophylaxis in contrast to targeted mild hypercarbia. Likelihood of not developing CDEs was higher for targeted mild hypercarbia. In contrast to rSO2, most prophylactic methods reduced hypotensive episodes. Conclusions: Targeted mild hypercarbia can reduce BCP-related CDEs. Evidence does not favor prophylactic use of vasoactive agents for the prevention of cerebral desaturations irrespective of whether their use interferes with cerebral oximetry readings.

#Arthroscopy #Oximetry #Prophylaxis #Randomized controlled trial #Shoulder #Sitting position #Statistics #Systematic review.

참고문헌 (46)

참고문헌 신청

Murphy GS / 2010 / Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions / Anesth Analg 111:496~505

Moerman AT / 2012 / Cerebral oxygen desaturation during beach chair position / Eur J Anaesthesiol 29:82~87

Hayashi K / 2017 / Effect of blood pressure elevation on cerebral oxygen desaturation in the beach chair position / Asian J Anesthesiol 55:13~16

고상훈 / 2012 / Cerebral oxygenation monitoring of patients during arthroscopic shoulder surgery in the sitting position / Korean Journal of Anesthesiology 63(4):297~301

Cardim D / 2019 / Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach / J Clin Monit Comput 33:615~625

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