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Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach.

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cam.issuedOnline2018-10-17
dc.contributor.authorCardim, Danilo
dc.contributor.authorRobba, Chiara
dc.contributor.authorMatta, Basil
dc.contributor.authorTytherleigh-Strong, Graham
dc.contributor.authorKang, Niel
dc.contributor.authorSchmidt, Bernhard
dc.contributor.authorDonnelly, Joseph
dc.contributor.authorCalviello, Leanne
dc.contributor.authorSmielewski, Peter
dc.contributor.authorCzosnyka, Marek
dc.contributor.orcidCardim, Danilo [0000-0002-9261-1321]
dc.date.accessioned2018-11-23T00:32:43Z
dc.date.available2018-11-23T00:32:43Z
dc.date.issued2019-08
dc.description.abstractAlthough the beach-chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of brain ischaemia. We assessed cerebral haemodynamics using a multiparameter transcranial Doppler-derived approach in patients undergoing shoulder surgery. 23 anaesthetised patients (propofol (2 mg/kg)) without history of neurologic pathology undergoing elective shoulder surgery were included. Arterial blood pressure (ABP, monitored with a finger-cuff plethysmograph calibrated at the auditory meatus level) and cerebral blood flow velocity (FV, monitored in the middle cerebral artery) were recorded in supine and in BCP. All subjects underwent interscalene block ipsilateral to the side of FV measurement. We evaluated non-invasive intracranial pressure (nICP) and cerebral perfusion pressure (nCPP) calculated with a black-box mathematical model; critical closing pressure (CrCP); diastolic closing margin (DCM-pressure reserve available to avoid diastolic flow cessation); cerebral autoregulation index (Mxa); pulsatility index (PI). Significant changes occured for DCM [mean decrease of 6.43 mm Hg (p = 0.01)] and PI [mean increase of 0.11 (p = 0.05)]. ABP, FV, nICP, nCPP and CrCP showed a decreasing trend. Cerebral autoregulation was dysfunctional (Mxa > 0.3) and PI deviated from normal ranges (PI > 0.8) in both phases. ABP and nCPP values were low (< 60 mm Hg) in both phases. Changes between phases did not result in CrCP reaching diastolic ABP, therefore DCM did not reach critical values (≤ 0 mm Hg). BCP resulted in significant cerebral haemodynamic changes. If left untreated, reduction in cerebral blood flow may result in brain ischaemia and post-operative neurologic deficit.
dc.description.sponsorshipICM+ software is licensed by the University of Cambridge, Cambridge Enterprise Ltd. MC and PS have a financial interest in a part of its licensing fee. The procedure of non-invasive ICP assessment is distributed as a plug-in for ICM+ monitoring software. BS and MC have financial interest in its licensing fee. The remaining authors declare no conflict of interest. Cambridge Commonwealth, European & International Trust Scholarship, University of Cambridge provided financial support in the form of Scholarship funding for DC. Woolf Fisher Trust provided financial support in the form of Scholarship funding for JD. NIHR Brain Injury Healthcare Technology Co-operative, Cambridge, UK, provided financial support in the form of equipment funding for DC and MC. The sponsors had no role in the design or conduct of this manuscript.
dc.format.mediumPrint-Electronic
dc.identifier.doi10.17863/CAM.33174
dc.identifier.eissn1573-2614
dc.identifier.issn1387-1307
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/285830
dc.languageeng
dc.language.isoeng
dc.publisherSpringer Science and Business Media LLC
dc.publisher.urlhttp://dx.doi.org/10.1007/s10877-018-0211-7
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectBeach chair position
dc.subjectCerebral autoregulation
dc.subjectNon-invasive intracranial pressure
dc.subjectTranscranial Doppler
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAnesthesia
dc.subjectArterial Pressure
dc.subjectBlood Flow Velocity
dc.subjectBrain
dc.subjectBrain Ischemia
dc.subjectCerebrovascular Circulation
dc.subjectFemale
dc.subjectHemodynamics
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectMonitoring, Physiologic
dc.subjectOxygen
dc.subjectPatient Positioning
dc.subjectPropofol
dc.subjectRisk
dc.subjectShoulder
dc.subjectSitting Position
dc.subjectUltrasonography, Doppler
dc.subjectUltrasonography, Doppler, Transcranial
dc.subjectYoung Adult
dc.titleCerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach.
dc.typeArticle
dcterms.dateAccepted2018-10-10
prism.endingPage625
prism.issueIdentifier4
prism.publicationDate2019
prism.publicationNameJ Clin Monit Comput
prism.startingPage615
prism.volume33
rioxxterms.licenseref.startdate2019-08
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1007/s10877-018-0211-7

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