Consequences of Beach Chair shoulder surgery

When concepts of and monitoring techniques to help maintain cerebral perfusion are not appreciated there may be significant consequences for patients.  Cullen & Kirby described patients undergoing shoulder surgery in the Beach Chair position who suffered massive brain injury.  Though the exact causes may never be determined, Cullen & Kirby believe that in the cases they reviewed the blood pressure was inadequate to maintain cerebral perfusion (see APSF Newsletter 2007;22:25-27 and Pohl A & Cullen DJ: Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth 2004;17:463-469).  The safe principles for providing anesthesia in the sitting position have been worked out by generations of neuroanesthesiologists who have cared for patients in this position since the early 1900s.  Issues related to the fall in blood pressure at brain level compared to heart level when the patient is sitting, air emboli, sciatic neuropathy from excessive hip flexion, brachial plexopathy from shoulder sag, anterior spinal artery syndrome from excess neck flexion, lingual swelling from an oral airway combined with neck flexion, and buttock ulceration from the body weight being borne by the ischial tuberosities are well known as are the techniques that help minimize these risks (Smith DS & Osborne I: Posterior Fossa: Anesthetic considerations in Cottrell JE & Smith DS (eds): Anesthesia and Neurosurgery, 4^th edition, 2001 pages 335 – 351).

David S. Smith, M.D., Ph.D.

Comments

[High Blood Pressure Treatment]

High blood pressure can make a person’s life in risk in a number of ways. Elevated blood pressure effects not only heart but it can produce devastating effects for kidneys, cardiac muscles, strokes etc. If left unmonitored blood pressure can be dangerous to a certain extent.

[Julie Schumacher]

My husband underwent shoulder surgery (5 hours) in a chair. After the surgery, they retained him for two hours in observation. When he finally arrived to the room, the OR nurses were trading information with the night nurse and mentioned a large bump on his head (which nobody charted until the next day). The staff's explaination was that the 5 hours in the chair caused the lump - about the size of half of a baseball - on the backside of his head. Would someone please tell me if the beach chair position could cause an injury like this because of "positioning".