• Mohit N Gilotra, Ashley Klein, Nabil Elkassabany, Andrew F Kuntz, G Russell Huffman, and David L Glaser.
• University of Maryland School of Medicine, Department of Orthopaedics, Shoulder and Elbow Service, Baltimore, Maryland, U.S.A.. Electronic address: mgilitra@som.umaryland.edu.
• Arthroscopy. 2019 Mar 1; 35 (3): 725-730.

PurposeThe goals of this study were 2-fold: (1) to determine the risk factors for cerebral desaturation events (CDEs) after implementation of a comprehensive surgical and anesthetic protocol consisting of patient risk stratification, maintenance of normotensive anesthesia, and patient positioning in a staged fashion, and (2) to assess for subclinical neurologic decline associated with intraoperative ischemic events through cognitive testing.MethodsOne hundred patients undergoing shoulder surgery in the beach chair position were stratified for risk of CDE based on Framingham stroke criteria, body mass index (BMI), and history of cerebrovascular accidents. Cerebral oxygen saturation was monitored with near-infrared spectroscopy. As per a standardized protocol, mean arterial pressure was maintained between 70 and 90 mm Hg. The head was raised in 2 stages separated by 3 minutes. CDE were defined as >20% drop from baseline or <55% O2 absolute threshold. Patients completed a Mini-Mental State Examination during preoperative examination and at the first postoperative visit.ResultsThe CDE rate was 4% overall and 4.3% in patients undergoing general anesthesia. Forty-five patients were in the higher risk category, and all CDEs occurred in that group. Patients with a Framingham score ≥ 10 or BMI ≥ 35 who underwent general anesthesia had an increased risk of CDE (P = .04). No significant change was noted in Mini-Mental State Examination scores between pre- and postoperative visits. No correlation was shown between CDE and history of diabetes, smoking, cardiovascular disease, or left ventricular hypertrophy.ConclusionsOur observed CDE rate was lower than previously reported rates, likely because of risk stratification, staged positioning, and normotensive anesthesia. Framingham score ≥ 10 and BMI ≥ 35 are risk factors for CDE in the beach chair position.Level Of EvidenceLevel II, prospective observational study with >80% follow-up.Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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