Beach Chair Positioning for Shoulder Surgery: Implications for Cerebral Oxygenation
Introduction
Shoulder arthroscopy is a minimally invasive surgical procedure commonly performed in the beach chair or lateral decubitus positions. The beach chair position, with the patient seated upright, has been associated with reductions in regional brain oxygenation, cerebral autoregulation, and postoperative cognitive dysfunction.
Clinical Trials and Regional Brain Oxygenation
Most clinical trials have demonstrated significant reductions in regional brain oxygenation cerebral with beach chair positioning during shoulder arthroscopy. This decrease in oxygenation is primarily attributed to the increased gravitational pressure on the brain, which impairs cerebral blood flow.
Arm and Head Positioning
Proper positioning of the arms and head is crucial to mitigate the negative effects on cerebral oxygenation. The arms should be placed in a neutral position to prevent compression of the brachial plexus or axillary artery. The head should be elevated to reduce the gravitational pressure on the brain.
Lateral Decubitus Position as an Alternative
The lateral decubitus position, where the patient lies on their side, is an alternative to the beach chair position that preserves cerebral oxygenation better. This position allows for a more even distribution of gravitational forces across the body, reducing the pressure on the brain.
Conclusion
Beach chair positioning during shoulder arthroscopy can lead to reductions in regional brain oxygenation, but careful positioning techniques can mitigate these effects. Clinicians should consider the risks and benefits of each positioning technique and choose the one that best suits the individual patient.
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