Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach

Danilo Cardim, Chiara Robba, Basil Matta, Graham Tytherleigh-Strong, Niel Kang, Bernhard Schmidt, Joseph Donnelly, Leanne Calviello, Peter Smielewski, Marek Czosnyka

Research output: Contribution to journalArticle

Abstract

Although the beach-chair position (BCP) is widely used during shoulder surgery, it has been reported to associate with a reduction in cerebral blood flow, oxygenation, and risk of brain ischaemia. We assessed cerebral haemodynamics using a multiparameter transcranial Doppler-derived approach in patients undergoing shoulder surgery. 23 anaesthetised patients (propofol (2 mg/kg)) without history of neurologic pathology undergoing elective shoulder surgery were included. Arterial blood pressure (ABP, monitored with a finger-cuff plethysmograph calibrated at the auditory meatus level) and cerebral blood flow velocity (FV, monitored in the middle cerebral artery) were recorded in supine and in BCP. All subjects underwent interscalene block ipsilateral to the side of FV measurement. We evaluated non-invasive intracranial pressure (nICP) and cerebral perfusion pressure (nCPP) calculated with a black-box mathematical model; critical closing pressure (CrCP); diastolic closing margin (DCM—pressure reserve available to avoid diastolic flow cessation); cerebral autoregulation index (Mxa); pulsatility index (PI). Significant changes occured for DCM [mean decrease of 6.43 mm Hg (p = 0.01)] and PI [mean increase of 0.11 (p = 0.05)]. ABP, FV, nICP, nCPP and CrCP showed a decreasing trend. Cerebral autoregulation was dysfunctional (Mxa > 0.3) and PI deviated from normal ranges (PI > 0.8) in both phases. ABP and nCPP values were low (< 60 mm Hg) in both phases. Changes between phases did not result in CrCP reaching diastolic ABP, therefore DCM did not reach critical values (≤ 0 mm Hg). BCP resulted in significant cerebral haemodynamic changes. If left untreated, reduction in cerebral blood flow may result in brain ischaemia and post-operative neurologic deficit.

Original languageEnglish
JournalJournal of Clinical Monitoring and Computing
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Cerebrovascular Circulation
Intracranial Pressure
Brain Ischemia
Homeostasis
Hemodynamics
Pressure
Blood Flow Velocity
Middle Cerebral Artery
Propofol
Neurologic Manifestations
Nervous System
Fingers
Arterial Pressure
Reference Values
Theoretical Models
Pathology
Blood Pressure

Keywords

  • Beach chair position
  • Cerebral autoregulation
  • Non-invasive intracranial pressure
  • Transcranial Doppler

ASJC Scopus subject areas

  • Health Informatics
  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

Cite this

Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach. / Cardim, Danilo; Robba, Chiara; Matta, Basil; Tytherleigh-Strong, Graham; Kang, Niel; Schmidt, Bernhard; Donnelly, Joseph; Calviello, Leanne; Smielewski, Peter; Czosnyka, Marek.

In: Journal of Clinical Monitoring and Computing, 01.01.2018.

Research output: Contribution to journalArticle

Cardim, Danilo ; Robba, Chiara ; Matta, Basil ; Tytherleigh-Strong, Graham ; Kang, Niel ; Schmidt, Bernhard ; Donnelly, Joseph ; Calviello, Leanne ; Smielewski, Peter ; Czosnyka, Marek. / Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach. In: Journal of Clinical Monitoring and Computing. 2018.
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AU - Cardim, Danilo

AU - Robba, Chiara

AU - Matta, Basil

AU - Tytherleigh-Strong, Graham

AU - Kang, Niel

AU - Schmidt, Bernhard

AU - Donnelly, Joseph

AU - Calviello, Leanne

AU - Smielewski, Peter

AU - Czosnyka, Marek

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