Hanouz Jean-Luc, Fiant Anne-Lise, Gérard Jean-Louis
Pôle Réanimations Anesthésie SAMU, CHU de Caen, Avenue Côte de Nacre, 14033 Caen cedex, France; Laboratoire de Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, EA 4650, Université Caen Basse Normandie, France.
Pôle Réanimations Anesthésie SAMU, CHU de Caen, Avenue Côte de Nacre, 14033 Caen cedex, France.
J Clin Anesth. 2016 Sep;33:31-6. doi: 10.1016/j.jclinane.2016.01.009. Epub 2016 Apr 6.
The goal of the present study was to examine changes of middle cerebral artery (VMCA) blood flow velocity in patients scheduled for shoulder surgery in beach chair position.
Prospective observational study.
Operating room, shoulder surgery.
Fifty-three consecutive patients scheduled for shoulder surgery in beach chair position.
Transcranial Doppler performed after induction of general anesthesia (baseline), after beach chair positioning (BC1), during surgery 20minutes (BC2), and after back to supine position before stopping anesthesia (supine).
Mean arterial pressure (MAP), end-tidal CO2, and volatile anesthetic concentration and VMCA were recorded at baseline, BC1, BC2, and supine. Postoperative neurologic complications were searched.
Beach chair position induced decrease in MAP (baseline: 73±10mm Hg vs lower MAP recorded: 61±10mm Hg; P<.0001) requiring vasopressors and fluid challenge in 44 patients (83%). There was a significant decrease in VMCA after beach chair positioning (BC1: 33±10cm/s vs baseline: 39±14cm/s; P=.001). The VMCA at baseline (39±2cm/s), BC2 (35±14cm/s), and supine (39±14cm/s) were not different. The minimal alveolar concentration of volatile anesthetics, end-tidal CO2, SpO2, and MAP were not different at baseline, BC1, BC2, and supine.
Beach chair position resulted in transient decrease in MAP requiring fluid challenge and vasopressors and a moderate decrease in VMCA.
本研究的目的是检查计划在沙滩椅位进行肩部手术的患者大脑中动脉（VMCA）血流速度的变化。
前瞻性观察性研究。
手术室，肩部手术。
53例连续计划在沙滩椅位进行肩部手术的患者。
在全身麻醉诱导后（基线）、沙滩椅位摆放后（BC1）、手术20分钟时（BC2）以及恢复仰卧位且麻醉未结束前（仰卧位）进行经颅多普勒检查。
在基线、BC1、BC2和仰卧位时记录平均动脉压（MAP）、呼气末二氧化碳分压、挥发性麻醉剂浓度和VMCA。搜索术后神经系统并发症。
沙滩椅位导致MAP下降（基线：73±10mmHg vs记录到的最低MAP：61±10mmHg；P<.0001），44例患者（83%）需要血管升压药和液体补充。沙滩椅位摆放后VMCA显著下降（BC1：33±10cm/s vs基线：39±14cm/s；P=.001）。基线时（39±2cm/s）、BC2时（35±14cm/s）和仰卧位时（39±14cm/s）的VMCA无差异。基线、BC1、BC2和仰卧位时挥发性麻醉剂的最低肺泡浓度（MAC）、呼气末二氧化碳分压、SpO2和MAP无差异。
沙滩椅位导致MAP短暂下降，需要液体补充和血管升压药，VMCA中度下降。
