Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Acta Anaesthesiol Scand. 2012 Aug;56(7):872-9. doi: 10.1111/j.1399-6576.2012.02716.x. Epub 2012 May 10.
Patients undergoing surgery in beach chair position (BCP) are at risk of cerebral ischaemia. We determined the prevalence and risk factors of jugular venous bulb oxygen desaturation (SjvO(2) < 50%) in BCP. It was also examined whether regional cerebral tissue oxygen saturation (SctO(2) ) measured by near-infrared spectroscopy and SjvO(2) are interchangeable for assessment of cerebral oxygenation.
Fifty-six consecutive patients undergoing arthroscopic shoulder surgery in BCP were studied. Anaesthesia was intravenous with propofol and remifentanil (P/R) or inhalational with sevoflurane and 50% nitrous oxide (S/N) depending on provider choice. Mean arterial pressure (MAP), heart rate (HR), SjvO(2) , and SctO(2) were measured before (baseline; post-induction in supine position) and after the patients assumed BCP. Bland-Altman analysis was performed to measure the agreement between SctO(2) and SjvO(2) .
SjvO(2) , SctO(2) , MAP, and HR decreased significantly when patients were raised into BCP. Jugular desaturation occurred in 41% of patients (56% with P/R vs. 21% with S/N anaesthesia, P = 0.0077). Risk factors for the desaturation included P/R anaesthesia [adjusted odds ratio (aOR) 4.76, 95% confidence interval (CI) 1.34-16.95, P = 0.016] and MAP < 50 mmHg (aOR 3.85, 95% CI 1.21-12.25, P = 0.023). Bland-Altman analysis showed a mean difference of -8.9% with 95% limit of agreement between -40.0% and 23.0%. The percentage error [1.96 standard deviation/mean of the reference method] was 48.5%.
The incidence of jugular desaturation in BCP was 41%, and P/R anaesthesia and hypotension were associated with its occurrence while undergoing surgery under general anaesthesia. SctO(2) may not replace SjvO(2) for the determination of cerebral oxygenation.
接受沙滩椅体位（BCP）手术的患者存在脑缺血风险。我们确定了 BCP 中颈内静脉球血氧饱和度降低（SjvO₂<50%）的发生率和危险因素。还检查了通过近红外光谱测量的局部脑组织氧饱和度（SctO₂）和 SjvO₂是否可互换用于评估脑氧合。
连续研究了 56 例在 BCP 下行关节镜肩关节手术的患者。根据提供者的选择，麻醉采用异丙酚和瑞芬太尼的静脉注射（P/R）或七氟醚和 50%氧化亚氮的吸入（S/N）。在患者处于 BCP 前（仰卧位诱导后的基线）和之后测量平均动脉压（MAP）、心率（HR）、SjvO₂和 SctO₂。进行 Bland-Altman 分析以测量 SctO₂和 SjvO₂之间的一致性。
当患者升高到 BCP 时，SjvO₂、SctO₂、MAP 和 HR 显著降低。41%的患者出现颈内静脉缺氧（P/R 麻醉组为 56%，S/N 麻醉组为 21%，P=0.0077）。缺氧的危险因素包括 P/R 麻醉[校正优势比（aOR）4.76，95%置信区间（CI）1.34-16.95，P=0.016]和 MAP<50mmHg[aOR 3.85，95%CI 1.21-12.25，P=0.023]。Bland-Altman 分析显示平均差异为-8.9%，95%一致性界限为-40.0%至 23.0%。百分比误差[参考方法的 1.96 标准差/平均值]为 48.5%。
BCP 中颈内静脉球缺氧的发生率为 41%，P/R 麻醉和低血压与全身麻醉下手术时缺氧的发生相关。SctO₂可能无法替代 SjvO₂来确定脑氧合。
