Anästhesie in der Orthopädie / Unfallchirurgie – Narkoseführung und Kreislauf-management in sitzender Position

Zusammenfassung

Jährlich werden tausende Patienten in sitzender Position operiert. Meist handelt es sich um die Beach-Chair-Lagerung (BCL). Durch Fallberichte über deletäre neurologische Verläufe nach Operationen in BCL und Allgemeinanästhesie wird die Sicherheit der BCL unter Allgemeinanästhesie kontrovers diskutiert. Diese Übersichtsarbeit stellt die lagerungsbedingten Komplikationsmöglichkeiten dar und gibt Hilfestellung für die tägliche Praxis.

Abstract

Every year thousands of patients are operated in the sitting position. The most common position is the beach chair position. Due to case reports with deleterious neurologic outcome, the safety of the beach chair position in combination with general anesthesia is discussed controversially. In this review article the possible complications according to the beach chair position are explained and practical advice is given for the daily anesthetic routine.

Schlüsselwörter:

Beach-Chair-Lagerung - sitzende Lagerung - Hypotension - Allgemeinanästhesie - Regionalanästhesie

Key words:

beach chair position - sitting position - hypotension - general anesthesia - regional anesthesia

• Literatur

• 1 Drummond JC, Lee RR, Howell Jr. JP. Focal cerebral ischemia after surgery in the „beach chair“ position: the role of a congenital variation of circle of Willis anatomy. AnesthAnalg 2012; 114: 1301-1303
• 2 Koga T, Miyao M, Sato M et al. Pituitary apoplexy during general anesthesia in beach chair position for shoulder joint arthroplasty. J Anesth 2010; 24: 476-478
• 3 Bhatti MT, Enneking FK. Visual loss and ophthalmoplegia after shoulder surgery. AnesthAnalg 2003; 96: 899-902
• 4 Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J ClinAnesth 2005; 17: 463-469
• 5 Pin-on P, Schroeder D, Munis J. The hemodynamic management of 5177 neurosurgical and orthopedic patients who underwent surgery in the sitting or „beach chair“ position without incidence of adverse neurologic events. AnesthAnalg 2013; 116: 1317-1324
• 6 Friedman DJ, Parnes NZ, Zimmer Z et al. Prevalence of cerebrovascular events during shoulder surgery and association with patient position. Orthopedics 2009; 32: 256-261
• 7 Lam AM, Baldwin G. Blood pressure and adverse perioperative neurologic outcomes: an uncomfortable position. AnesthAnalg 2012; 114: 1156-1159
• 8 Valenza F, Vagginelli F, Tiby A et al. Effects of the beach chair position, positive end-expiratory pressure, and pneumoperitoneum on respiratory function in morbidly obese patients during anesthesia and paralysis. Anesthesiology 2007; 107: 725-732
• 9 Buhre W, Weyland A, Buhre K et al. Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures. Br J Anaesth 2000; 84: 354-357
• 10 Jo YY, Jung WS, Kim HS et al. Prediction of hypotension in the beach chair position during shoulder arthroscopy using pre-operative hemodynamic variables. J ClinMonitComput 2014; 28: 173-178
• 11 Trentman TL, Fassett SL, Thomas JK et al. More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position. Can J Anaesth 2011; 58: 993-1000
• 12 Benes J, Simanova A, Tovarnicka T et al. Continuous non-invasive monitoring improves blood pressure stability in upright position: randomized controlled trial. J ClinMonitComput 2015; 29: 11-17
• 13 Walsh M, Devereaux PJ, Garg AX et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology 2013; 119: 507-515
• 14 Closhen D, Berres M, Werner C et al. Influence of beach chair position on cerebral oxygen saturation: a comparison of INVOS and FORE-SIGHT cerebral oximeter. J NeurosurgAnesthesiol 2013; 25: 414-419
• 15 Koh JL, Levin SD, Chehab EL et al. Neer Award 2012: cerebral oxygenation in the beach chair position: a prospective study on the effect of general anesthesia compared with regional anesthesia and sedation. J Shoulder Elbow Surg 2013; 22: 1325-1331
• 16 Lee JH, Min KT, Chun YM et al. Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery. Arthroscopy 2011; 27: 889-894
• 17 Moerman AT, De Hert SG, Jacobs TF et al. Cerebral oxygen desaturation during beach chair position. Eur J Anaesthesiol 2012; 29: 82-87
• 18 Murphy GS, Szokol JW, Marymont JH et al. Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions. AnesthAnalg 2010; 111: 496-505
• 19 Pant S, Bokor DJ, Low AK. Cerebral oxygenation using near-infrared spectroscopy in the beach-chair position during shoulder arthroscopy under general anesthesia. Arthroscopy 2014; 30: 1520-1527
• 20 Cullen DJ, Kirby RR. Beach chair position may decrease cerebral perfusion: catastrophic outcomes have occurred. APSF Newsletter 2007; 22: 25-27
• 21 Drummond JC, Hargens AR, Patel PM. Hydrostatic gradient ist important: blood pressure should be corrected. APSF Newsletter 2009; 24: 6-6
• 22 Weyland A, Grüne F. Intraoperative hypotension – update on pathophysiology and clinical implications. AnästhIntensivmed 2013; 54: 381-390
• 23 Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev 1990; 2: 161-192
• 24 Laflam A, Joshi B, Brady K et al. Shoulder surgery in the beach chair position is associated with diminished cerebral autoregulation but no differences in postoperative cognition or brain injury biomarker levels compared with supine positioning: the anesthesia patient safety foundation beach chair study. AnesthAnalg 2015; 120: 176-185
• 25 Drummond JC. The lower limit of autoregulation: time to revise our thinking?. Anesthesiology 1997; 86: 1431-1433
• 26 Kwak HJ, Lee JS, Lee DC et al. The effect of a sequential compression device on hemodynamics in arthroscopic shoulder surgery using beach-chair position. Arthroscopy 2010; 26: 729-733
• 27 Morrison DS, Schaefer RK, Friedman RL. The relationship between subacromial space pressure, blood pressure, and visual clarity during arthroscopic subacromial decompression. Arthroscopy 1995; 11: 557-560
• 28 Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy 2011; 27: 532-541
• 29 Gillespie R, Shishani Y, Streit J et al. The safety of controlled hypotension for shoulder arthroscopy in the beach-chair position. J Bone Joint Surg Am 2012; 94: 1284-1290
• 30 Aguirre J, Borgeat A, Trachsel T et al. Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: Comparing general to regional anesthesia and the impact on neurobehavioral outcome. Rev EspAnestesiolReanim 2014; 61: 64-72
• 31 D'Alessio JG, Weller RS, Rosenblum M. Activation of the Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy using interscalene block. AnesthAnalg 1995; 80: 1158-1162
• 32 Kahn RL, Hargett MJ. Beta-adrenergic blockers and vasovagal episodes during shoulder surgery in the sitting position under interscalene block. AnesthAnalg 1999; 88: 378-381
• 33 Sia S, Sarro F, Lepri A et al. The effect of exogenous epinephrine on the incidence of hypotensive/bradycardic events during shoulder surgery in the sitting position during interscalene block. AnesthAnalg 2003; 97: 583-588
• 34 Kinsella SM, Tuckey JP. Perioperative bradycardia and asystole: relationship to vasovagal syncope and the Bezold-Jarisch reflex. Br J Anaesth 2001; 86: 859-868
• 35 Liguori GA, Kahn RL, Gordon J et al. The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. AnesthAnalg 1998; 87: 1320-1325
• 36 Jeong H, Jeong S, Lim HJ et al. Cerebral oxygen saturation measured by near-infrared spectroscopy and jugular venous bulb oxygen saturation during arthroscopic shoulder surgery in beach chair position under sevoflurane-nitrous oxide or propofol-remifentanil anesthesia. Anesthesiology 2012; 116: 1047-1056
• 37 D'Alessio JG, Rosenblum M, Shea KP et al. A retrospective comparison of interscalene block and general anesthesia for ambulatory surgery shoulder arthroscopy. RegAnesth 1995; 20: 62-68
• 38 Yadeau JT, Casciano M, Liu SS et al. Stroke, regional anesthesia in the sitting position, and hypotension: a review of 4169 ambulatory surgery patients. RegAnesth Pain Med 2011; 36: 430-435
• 39 Rohrbaugh M, Kentor ML, Orebaugh SL et al. Outcomes of shoulder surgery in the sitting position with interscalene nerve block: a single-center series. RegAnesth Pain Med 2013; 38: 28-33
• 40 Janssen H, Stosch R, Poschl R et al. Blood pressure response to combined general anaesthesia/interscalene brachial plexus block for outpatient shoulder arthroscopy. BMC Anesthesiol 2014; 14: 50-50
• 41 Dagal A, Lam AM. Cerebral autoregulation and anesthesia. CurrOpinAnaesthesiol 2009; 22: 547-552
• 42 Murphy GS, Szokol JW, Avram MJ et al. Effect of ventilation on cerebral oxygenation in patients undergoing surgery in the beach chair position: a randomized controlled trial. Br J Anaesth 2014; 113: 618-627
• 43 Lee L, Caplan R. APSF Workshop: Cerebral perfusion experts share views on management of head-up cases. APSF Newsletter 2009; 24: 45-48