Clinical Orthopaedics and Related Research®

, Volume 471, Issue 12, pp 4027–4034 | Cite as

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

  • Dane Salazar
  • Benjamin W. Sears
  • John Andre
  • Pietro Tonino
  • Guido Marra
Clinical Research

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Notes

Acknowledgments

We thank the staff of the Loyola Ambulatory Surgical Center at Oak Brook for their support of this project. Without their hard work and dedication, this endeavor would not have been possible. We also thank Rong Guo for her statistical analysis of our data.

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Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • Dane Salazar
    • 1
  • Benjamin W. Sears
    • 1
  • John Andre
    • 1
  • Pietro Tonino
    • 1
  • Guido Marra
    • 2
  1. 1.Department of Orthopaedic Surgery and RehabilitationLoyola University Health SystemMaywoodUSA
  2. 2.Department of Orthopaedic SurgeryNorthwestern UniversityChicagoUSA

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