Anesthesia for arthroscopic shoulder surgery in the beach chair position: monitoring of cerebral oxygenation using combined bispectral index and near-infrared spectroscopy.

Abstract

Recent research has shown that cerebrovascular complications following shoulder surgery performed in the beach chair position under general anesthesia arise secondary to cerebral ischemia. Appropriate management of cerebral oxygenation is thus one of the primary goals of anesthetic management during such procedures. The present report describes the case of a 65-year-old male patient, in which both bispectral index (BIS) and near-infrared spectroscopy (NIRS) were used to monitor cerebral oxygenation. During the positioning, we observed an increased suppression ratio (SR) while BIS and regional cerebral oxygen saturation (rSO2) were at adequate level. In view of the difference in blood pressure between the heart and the base of the brain, blood pressure was maintained to ensure adequate cerebral perfusion. Although intraoperative rSO2 was at or around the cut-off point (a 12% relative decrease from baseline), no marked decrease in BIS or further increase in the SR was observed. Monitoring of cerebral perfusion using combined BIS and NIRS optimized anesthetic management during the performance of arthroscopic shoulder surgery in the beach chair position.