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Influence of Beach Chair Position on Cerebral Oxygen Saturation: A Comparison of INVOS and FORE-SIGHT Cerebral Oximeter

Closhen, Dorothea MD*; Berres, Manfred PhD†,‡; Werner, Christian MD, PhD*; Engelhard, Kristin MD, PhD*; Schramm, Patrick MD*

Journal of Neurosurgical Anesthesiology: October 2013 - Volume 25 - Issue 4 - p 414–419
doi: 10.1097/ANA.0b013e3182973349
Clinical Reports

Background: Although beach chair position (BCP) is frequently used for shoulder surgery, a potentially detrimental influence on cerebral oxygenation is discussed. Therefore, the present study investigated changes in regional cerebral oxygen saturation (rSO2/StO2) during BCP comparing 2 different devices for near-infrared spectroscopy measurement.

Methods: Data were collected in 35 patients undergoing shoulder surgery in BCP and compared with a control group of 35 awake volunteers. The rSO2/StO2 was assessed using INVOS and FORE-SIGHT monitors. Mean arterial blood pressure (MAP), peripheral oxygen saturation (SpO2), PeCO2, FiO2, end-tidal sevoflurane concentration, and rSO2/StO2 were measured before positioning, during BCP, and in supine position after surgery.

Results: A decrease in rSO2/StO2 could be observed after BCP (INVOS: 76.1% supine vs. 66.7% BCP, P<0.001; FORE-SIGHT: 78.6% supine, 66.1% BCP, P<0.001), which was reversible in supine position. This decrease correlated with MAP during BCP, while in supine position no correlation was detected. In control group BCP did not influence rSO2/StO2. Changes detected with INVOS or FORE-SIGHT cerebral oximeter did not differ.

Conclusion: BCP is associated with a decrease in rSO2/StO2 of 10% in anesthetized patients, which is reversible after repositioning. No changes occurred in supine position under general anesthesia as well as in awake subjects in BCP. This underlines the assumption that vasodilation by anesthetics in combination with BCP evoke a drop in rSO2/StO2. A strict hemodynamic management may be necessary to prevent desaturation events. Despite different technology used by the devices, the results of INVOS and FORE-SIGHT cerebral oximeters are comparable.

*Department of Anaesthesiology

Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre of the Johannes Gutenberg-University Mainz, Mainz

RheinAhrCampus, Remagen, Germany

Part of the data presented in this manuscript are part of a doctoral thesis of Daniel Kaiser (Medical Student, Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany).

The authors have no funding or conflicts of interest to disclose.

Reprints: Dorothea Closhen, MD, Department of Anaesthesiology, Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, Mainz 55131, Germany (e-mail:

Received December 11, 2012

Accepted April 15, 2013

© 2013 by Lippincott Williams & Wilkins