Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA.
J Shoulder Elbow Surg. 2018 Apr;27(4):692-700. doi: 10.1016/j.jse.2017.11.004. Epub 2018 Feb 1.
Beach chair positioning for shoulder surgery is associated with measurable cerebral desaturation events (CDEs) in up to 80% of patients. Near-infrared spectroscopy (NIRS) technology allows real-time measurement of cerebral oxygenation and may minimize the frequency of CDEs. The purpose of this study was to investigate the incidence of CDEs when anesthetists were aware of and blinded to NIRS monitoring and to determine the short-term cognitive effects of surgery in the beach chair position.
NIRS was used to monitor cerebral oxygenation saturation in 41 consecutive patients undergoing arthroscopic shoulder surgery in the beach chair position. Patients were randomized to 2 groups, anesthetists aware of or blinded to NIRS data. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive function preoperatively, immediately postoperatively, and at 2 and 6 weeks postoperatively.
Overall, 7 (17.5%) patients experienced a CDE, 5 (25%) in the aware group and 2 (10%) in the blinded group. There was no significant difference in MoCA scores between the aware and blinded groups preoperatively (27.9.1 vs. 28.2; P = .436), immediately postoperatively (26.1 vs. 26.2; P = .778), 2 weeks postoperatively (28.0 vs. 28.1; P = .737), or 6 weeks postoperatively (28.5 vs. 28.4; P = .779). There was a correlation of NIRS with systolic blood pressure (r = 0.448), diastolic blood pressure (r = 0.708), and mean arterial pressure (r = 0.608).
In our series, the incidence of CDEs was much lower than previously reported and was not lowered by use of NIRS. Patients did not have significant cognitive deficits after arthroscopic surgery in the beach chair position, and there was a correlation between NIRS and intraoperative brachial blood pressure.
沙滩椅体位用于肩部手术时，高达 80%的患者会出现可测量的脑氧合降低事件（CDE）。近红外光谱（NIRS）技术可实时测量脑氧合情况，并可能减少 CDE 的发生频率。本研究旨在探讨麻醉师知晓和盲法使用 NIRS 监测时 CDE 的发生率，并确定沙滩椅体位下手术的短期认知影响。
连续 41 例行关节镜下肩部手术的患者采用 NIRS 监测脑氧饱和度。患者随机分为 2 组，麻醉师知晓或盲法 NIRS 数据。采用蒙特利尔认知评估（MoCA）评估术前、术后即刻及术后 2 周和 6 周的认知功能。
总体而言，7 例（17.5%）患者出现 CDE，知晓组 5 例（25%），盲法组 2 例（10%）。两组患者术前 MoCA 评分无显著差异（27.9.1 分 vs. 28.2 分；P=0.436），术后即刻（26.1 分 vs. 26.2 分；P=0.778）、术后 2 周（28.0 分 vs. 28.1 分；P=0.737）及术后 6 周（28.5 分 vs. 28.4 分；P=0.779）。NIRS 与收缩压（r=0.448）、舒张压（r=0.708）和平均动脉压（r=0.608）呈相关性。
在本研究中，CDE 的发生率远低于既往报道，且使用 NIRS 并不能降低其发生率。沙滩椅体位下关节镜手术后患者认知功能无明显缺损，NIRS 与术中肱动脉血压之间存在相关性。
