BACKGROUND:Several case reports have raised serious concerns about the safety of shoulder surgery in the beach-chair position, related to global cerebral hypoperfusion. We summarize our experiences with 15,014 cases of shoulder arthroscopy over an 11-year period. Our primary aim was to evaluate the incidence of intraoperative or immediate postoperative neurologic events and secondarily to relate other perioperative complications. METHODS:We searched our online deidentified departmental quality improvement and patient safety database for adverse outcomes associated with arthroscopic shoulder surgery performed in the beach-chair position for the 11-year period between April 2001 and November 2011, as well as our hospital-system database and a statewide database. This was compared with the total number of such cases, available from our department billing database. RESULTS:The total rate of adverse events was 0.37%. Neurologic abnormalities suggestive of acute cerebral ischemia or hemorrhage did not occur in the immediate perioperative period. One new neurologic deficit was reported, secondary to ischemic stroke, which occurred 24 hours after the surgery. The most frequent complications detected were unplanned return to care (0.067%), local anesthetic systemic toxicity (0.053%), and airway compromise requiring unplanned intubation (0.033%). Complications were infrequent and did not vary in incidence over the course of the study. CONCLUSIONS:This retrospective study suggests that intraoperative or immediate postoperative stroke is rare when surgery is conducted in beach-chair position in conjunction with regional anesthesia, propofol sedation, and spontaneous respiration via natural airway.

译文

背景:几例病例报告引起了人们对与全脑低灌注相关的沙滩椅位置肩部手术安全性的严重关注。我们总结了我们在11年中共15014例肩关节镜检查的经验。我们的主要目的是评估术中或术后立即发生的神经系统事件的发生率,其次是与其他围手术期并发症相关。
方法:我们在2001年4月至2011年11月的11年期间,通过在线不确定的部门质量改善和患者安全性数据库搜索了在沙滩椅位置进行的关节镜肩部手术相关的不良结局,以及医院系统数据库和全州数据库。将其与此类案件的总数进行了比较,可从我们的部门账单数据库中获得该数目。
结果:不良反应总发生率为0.37%。围手术期未发生提示急性脑缺血或出血的神经系统异常。据报道,缺血性中风继发于术后24小时,出现了一种新的神经功能缺损。发现的最常见并发症是计划外恢复治疗(0.067%),局麻药全身毒性(0.053%)和需要计划外插管的气道损害(0.033%)。在研究过程中,并发症很少见,发生率也没有变化。
结论:这项回顾性研究表明,当在沙滩椅位置进行手术并伴有区域麻醉,异丙酚镇静和通过自然气道自发呼吸时,很少发生术中或术后中风。

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