Ventilation Strategies, Anesthetic Techniques and Cerebral Oxygenation in the Beach Chair Position
| Status: | Completed |
|---|---|
| Conditions: | Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 85 |
| Updated: | 11/8/2014 |
| Start Date: | September 2012 |
| End Date: | September 2014 |
| Contact: | Amy Shanks, MS |
| Email: | amysha@med.umich.edu |
| Phone: | 734-936-0063 |
The Influence of Basic Ventilation Strategies and Anesthetic Techniques on Cerebral Oxygenation in the Beach Chair Position
The seated or "beach chair" position during surgery and general anesthesia decreases brain
oxygen levels and can result in stroke. As such, poor neurological outcome following beach
chair positioning is a growing concern. In the proposed study the investigators test the
hypothesis that changes in ventilation strategy and anesthetic technique can affect cerebral
oxygenation in anesthetized patients in the beach chair position.
oxygen levels and can result in stroke. As such, poor neurological outcome following beach
chair positioning is a growing concern. In the proposed study the investigators test the
hypothesis that changes in ventilation strategy and anesthetic technique can affect cerebral
oxygenation in anesthetized patients in the beach chair position.
This is a prospective cohort study with randomized nested design. Patients presenting for
shoulder surgery will be randomized to receive desflurane or total intravenous anesthesia
with propofol. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor
(Covidien, Boulder, CO). Depth of anesthesia will be maintained within a Bispectral Index
range of 40-60. Following positioning, inspired oxygen fraction and minute ventilation will
be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded
and venous blood gas analysis performed. Statistical analysis will be repeated measures
analysis of variance in which ventilation strategy is the within-subjects factor and
anesthetic technique is the between-subjects factor; post hoc Tukey's correction will be
used for multiple comparisons. If simple maneuvers of ventilation and anesthetic technique
can prevent low brain oxygen levels, patient outcome may be improved.
shoulder surgery will be randomized to receive desflurane or total intravenous anesthesia
with propofol. Regional cerebral oxygenation will be measured using the INVOS 5100C monitor
(Covidien, Boulder, CO). Depth of anesthesia will be maintained within a Bispectral Index
range of 40-60. Following positioning, inspired oxygen fraction and minute ventilation will
be sequentially adjusted. At each set point, regional cerebral oxygenation will be recorded
and venous blood gas analysis performed. Statistical analysis will be repeated measures
analysis of variance in which ventilation strategy is the within-subjects factor and
anesthetic technique is the between-subjects factor; post hoc Tukey's correction will be
used for multiple comparisons. If simple maneuvers of ventilation and anesthetic technique
can prevent low brain oxygen levels, patient outcome may be improved.
Inclusion Criteria:
- scheduled for elective arthroscopic shoulder surgery in the beach chair position
under general anesthesia with supplemental interscalene block
Exclusion Criteria:
- refusal to give consent
- ineligible for interscalene block
- history of cardiovascular disease
- history of cerebrovascular disease
- hypertension
- respiratory failure
- non-English speaker
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