Department of Orthopaedic Surgery and Rehabilitation, Loyola University Health System, 2160 South First Avenue, Maywood, IL, 60153, USA,
Clin Orthop Relat Res. 2013 Dec;471(12):4027-34. doi: 10.1007/s11999-013-2987-6. Epub 2013 Apr 19.
Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia.
QUESTIONS/PURPOSES: We sought to define the (1) incidence; (2) timing; and (3) magnitude of intraoperative cerebral desaturation events (CDEs) in subjects undergoing arthroscopic shoulder surgery in the beach chair position, as well as whether (4) the length of surgery was an independent risk factor for intraoperative CDEs.
Regional cerebral tissue oxygen saturation (rSO2) was monitored intraoperatively using near-infrared spectroscopy on 51 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Intraoperative decreases in rSO2 of 20% or greater were defined as CDEs.
The incidence of intraoperative CDEs in our series was 18% (nine of 51). Among the patients demonstrating CDE (n = 9), the mean time to onset of initial CDE was 18 minutes 38 seconds postinduction. Of those experiencing CDEs, the mean maximal decrease in rSO2 was 32% from preoperative baseline per patient. Additionally, the mean number of separate CDE instances was 1.89 in this patient population with an average duration of 3 minutes 3 seconds per instance. There was no statistically significant difference (p = 0.202) between patients demonstrating CDEs and those without in regard to length of surgery (95 versus 88 minutes).
The degree and duration of cerebral ischemia required to produce neurocognitive dysfunction in this patient population remains undefined; however, cerebral oximetry with near-infrared spectroscopy allows prompt identification and treatment of decreased cerebral perfusion. We believe protocols aimed at detecting and reversing CDE may improve patient safety.
在沙滩椅体位下接受关节镜肩关节手术的患者可能由于脑缺血而增加发生严重神经认知并发症的风险。
问题/目的：我们旨在确定（1）发病率；（2）术中脑饱和度降低事件（CDE）的时间；（3）在沙滩椅体位下接受关节镜肩关节手术的患者中 CDE 的幅度，以及（4）手术时间是否是术中 CDE 的独立危险因素。
在 51 例连续接受沙滩椅体位下关节镜肩关节手术的患者中，使用近红外光谱术中监测局部脑组织氧饱和度（rSO2）。术中 rSO2 下降 20%或以上定义为 CDE。
我们的研究中术中 CDE 的发生率为 18%（51 例中有 9 例）。在出现 CDE 的患者中（n = 9），初始 CDE 的平均起始时间为诱导后 18 分钟 38 秒。发生 CDE 的患者，rSO2 平均最大下降幅度为术前基础值的 32%。此外，该患者人群中 CDE 发作的平均次数为 1.89 次，每次发作的平均持续时间为 3 分钟 3 秒。在 CDE 患者与无 CDE 患者之间，手术时间无统计学差异（p = 0.202）（95 分钟比 88 分钟）。
对于该患者人群，产生神经认知功能障碍所需的脑缺血程度和持续时间尚不清楚；然而，近红外光谱脑氧饱和度监测可快速识别和治疗脑灌注降低。我们认为旨在检测和逆转 CDE 的方案可能会提高患者安全性。
