From the Department of Anesthesiology, NorthShore University HealthSystem, University of Chicago Pritzker School of Medicine, Evanston, Illinois.
Anesth Analg. 2019 Jul;129(1):101-118. doi: 10.1213/ANE.0000000000004133.
Although uncommon, severe neurological events have been reported in patients undergoing shoulder surgery in the beach chair position. The presumed etiology of central nervous system injury is hypotension and subsequent cerebral hypoperfusion that occurs after alterations in positioning under general anesthesia. Most clinical trials have demonstrated that beach chair positioning results in reductions in regional brain oxygenation, cerebral blood flow, and jugular bulb oxygenation, as well as impairment in cerebral autoregulation and electroencephalographic/processed electroencephalographic variables. Further studies are needed to define the incidence of adverse neurological adverse events in the beach chair position, identify the best intraoperative neurological monitors that are predictive of neurocognitive outcomes, the lowest "safe" acceptable blood pressure during surgery for individual patients, and the optimal interventions to treat intraoperative hypotension.
虽然罕见，但有报道称在沙滩椅体位下进行肩部手术的患者发生严重神经系统事件。中枢神经系统损伤的推测病因是低血压和全身麻醉下体位改变后发生的脑灌注不足。大多数临床试验表明，沙滩椅体位会导致局部脑氧合、脑血流和颈静脉球血氧饱和度降低，以及脑自动调节和脑电图/处理脑电图变量受损。需要进一步研究来确定沙滩椅体位下不良神经不良事件的发生率，确定预测神经认知结果的最佳术中神经监测，每位患者手术期间可接受的最低“安全”血压，以及治疗术中低血压的最佳干预措施。
