• Christian Dippmann, Søren Winge, and Henning Bay Nielsen.
• Department of Orthopedic Surgery, Køge Hospital, Køge, Denmark. Christiandippmann@gmx.de
• Arthroscopy. 2010 Sep 1;26(9 Suppl):S148-50.

AbstractDuring shoulder arthroscopy in the beach-chair position, cerebral ischemia may be a serious complication because prolonged hypotension may affect regional cerebral oxygen supply. We present the cases of 2 patients in whom a reduction in mean arterial pressure after anesthesia provoked a decrease in frontal lobe oxygenation to below the level that causes presyncopal symptoms in the awake subject. In the healthy middle-aged patient, cerebral oxygenation decreased by approximately 40%, indicating that cerebral blood flow was markedly reduced, and intravenous administration of ephedrine rapidly restored cerebral oxygenation. During surgery in the beach-chair position, hypotension must be avoided, and in all patients regional, cerebral oxygenation should be monitored and optimized.

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