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Under General Anesthesia Arginine Vasopressin Prevents Hypotension but Impairs Cerebral Oxygenation During Arthroscopic Shoulder Surgery in the Beach Chair Position

Cho, Soo Y. MD; Kim, Seok J. MD, PhD; Jeong, Cheol W. MD, PhD; Jeong, Chang Y. MD, PhD; Chung, Sung S. MD, PhD; Lee, JongUn MD, PhD; Yoo, Kyung Y. MD, PhD

doi: 10.1213/ANE.0b013e3182a8fa97
Neuroscience in Anesthesiology and Perioperative Medicine: Research Report

BACKGROUND: Patients undergoing surgery in the beach chair position (BCP) are at a risk of cerebral ischemia. We evaluated the effect of arginine vasopressin (AVP) on hemodynamics and cerebral oxygenation during surgery in the BCP.

METHODS: Thirty patients undergoing shoulder surgery in BCP under propofol-remifentanil anesthesia were randomly allocated either to receive IV AVP 0.07 U/kg (AVP group, N = 15) or an equal volume of saline (control group, N = 15) 2 minutes before taking BCP. Mean arterial blood pressure (MAP), heart rate (HR), jugular venous bulb oxygen saturation (SjvO2), and regional cerebral tissue oxygen saturation (SctO2) were measured after induction of anesthesia and before (presitting in supine position) and after patients took BCP.

RESULTS: AVP itself given before the positioning increased MAP and decreased SjvO2 and SctO2 (P < 0.0001), with HR unaffected. Although MAP was decreased by BCP in both groups, it was higher in the AVP group (P < 0.0001). While in BCP, HR remained unaltered in the control and decreased in the AVP group. SjvO2 in BCP did not differ between the groups. SctO2 was decreased by BCP in both groups, which was more pronounced in the AVP group until the end of study. The incidence of hypotension (13% vs 67%; P = 0.003) was less frequent, and that of cerebral desaturation (>20% SctO2 decrease from presitting value) (80% vs 13%; P = 0.0003) was higher in the AVP group. The incidence of jugular desaturation (SjvO2 <50%) was comparable between the groups.

CONCLUSIONS: A prophylactic bolus administration of AVP prevents hypotension associated with BCP in patients undergoing shoulder surgery under general anesthesia. However, it was associated with regional cerebral but not jugular venous oxygen desaturation on upright positioning.

From the Department of Anesthesiology and Pain Medicine, School of Dentistry, Chonnam National University Medical School, Gwangju, South Korea.

Accepted for publication August 2, 2013.

Funding: This work was supported by the Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Gwangju, South Korea. The central venous oximetry catheter (PreSep™ Oximetry Catheter; Edwards Lifesciences, Irvine, CA) that was used for data collection in this study was provided free by Edwards Lifesciences Korea Corporation, Seoul, South Korea.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Kyung Yeon Yoo, MD, Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, 42 Jebong-ro, Dong-gu, Gwangju 501–757, South Korea. Address e-mail to kyyoo@jnu.ac.kr.

© 2013 International Anesthesia Research Society