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Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position

BACKGROUND: Shoulder arthroscopy is commonly performed in the beach chair position, which has been linked to cerebral oxygen desaturation. Previous studies comparing general anesthesia (GA) to total intravenous anesthesia (TIVA) using propofol indicate that TIVA can preserve cerebral perfusion and a...

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Autores principales: Barrera, Lindsay, Sharareh, Behnam, Tamma, Poornima, Shah, Anup
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328765/
https://www.ncbi.nlm.nih.gov/pubmed/37426922
http://dx.doi.org/10.1016/j.jseint.2023.04.009
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author Barrera, Lindsay
Sharareh, Behnam
Tamma, Poornima
Shah, Anup
author_facet Barrera, Lindsay
Sharareh, Behnam
Tamma, Poornima
Shah, Anup
author_sort Barrera, Lindsay
collection PubMed
description BACKGROUND: Shoulder arthroscopy is commonly performed in the beach chair position, which has been linked to cerebral oxygen desaturation. Previous studies comparing general anesthesia (GA) to total intravenous anesthesia (TIVA) using propofol indicate that TIVA can preserve cerebral perfusion and autoregulation, as well as shorten recovery time and reduce the incidence of postoperative nausea and vomiting. However, few studies have evaluated the use of TIVA in shoulder arthroscopy. Thus, this study seeks to determine if TIVA is superior to traditional GA methods in terms of improving operating room efficiency, shortening recovery time, and reducing adverse events while theoretically preserving cerebral autoregulation in patients undergoing shoulder arthroscopy in the beach chair position. METHODS: This is a retrospective study of patients undergoing shoulder arthroscopy in the beach chair position, comparing 2 anesthetic techniques. One hundred fifty patients were included (75 TIVA and 75 GA). Unpaired t-tests were used to determine statistical significance. Outcome measures included operating room times, recovery times, and adverse events. RESULTS: Compared to GA, TIVA significantly improved phase 1 recovery time (53.2 ± 32.9 min compared to 65.8 ± 41.3 min; P = .037) and total recovery time (120.3 ± 31.0 min compared to 131.5 ± 36.8 min; P = .048). TIVA also decreased time from case finish to out-of-room (6.5 ± 3.5 min compared to 8.4 ± 6.3 min; P = .021). However, the in-room to case start time was slightly longer for the TIVA group (31.8 ± 7.22 min compared to 29.2 ± 4.92 min; P = .012). Although not statistically significant, there were fewer readmissions in the TIVA group compared to the GA group (P = .08), and TIVA had lower rates of postoperative nausea and vomiting (P = .22) and higher intraoperative mean arterial pressures (87.1 ± 11.4 mmHg in the TIVA group compared to 85.0 ± 9.3 mmHg in the GA group; P = .22). CONCLUSION: TIVA may be a safe and efficient alternative to GA in shoulder arthroscopy in the beach chair position. Larger scale studies are needed to evaluate the risk of adverse events related to impaired cerebral autoregulation in the beach chair position.
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spelling pubmed-103287652023-07-09 Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position Barrera, Lindsay Sharareh, Behnam Tamma, Poornima Shah, Anup JSES Int Shoulder BACKGROUND: Shoulder arthroscopy is commonly performed in the beach chair position, which has been linked to cerebral oxygen desaturation. Previous studies comparing general anesthesia (GA) to total intravenous anesthesia (TIVA) using propofol indicate that TIVA can preserve cerebral perfusion and autoregulation, as well as shorten recovery time and reduce the incidence of postoperative nausea and vomiting. However, few studies have evaluated the use of TIVA in shoulder arthroscopy. Thus, this study seeks to determine if TIVA is superior to traditional GA methods in terms of improving operating room efficiency, shortening recovery time, and reducing adverse events while theoretically preserving cerebral autoregulation in patients undergoing shoulder arthroscopy in the beach chair position. METHODS: This is a retrospective study of patients undergoing shoulder arthroscopy in the beach chair position, comparing 2 anesthetic techniques. One hundred fifty patients were included (75 TIVA and 75 GA). Unpaired t-tests were used to determine statistical significance. Outcome measures included operating room times, recovery times, and adverse events. RESULTS: Compared to GA, TIVA significantly improved phase 1 recovery time (53.2 ± 32.9 min compared to 65.8 ± 41.3 min; P = .037) and total recovery time (120.3 ± 31.0 min compared to 131.5 ± 36.8 min; P = .048). TIVA also decreased time from case finish to out-of-room (6.5 ± 3.5 min compared to 8.4 ± 6.3 min; P = .021). However, the in-room to case start time was slightly longer for the TIVA group (31.8 ± 7.22 min compared to 29.2 ± 4.92 min; P = .012). Although not statistically significant, there were fewer readmissions in the TIVA group compared to the GA group (P = .08), and TIVA had lower rates of postoperative nausea and vomiting (P = .22) and higher intraoperative mean arterial pressures (87.1 ± 11.4 mmHg in the TIVA group compared to 85.0 ± 9.3 mmHg in the GA group; P = .22). CONCLUSION: TIVA may be a safe and efficient alternative to GA in shoulder arthroscopy in the beach chair position. Larger scale studies are needed to evaluate the risk of adverse events related to impaired cerebral autoregulation in the beach chair position. Elsevier 2023-05-19 /pmc/articles/PMC10328765/ /pubmed/37426922 http://dx.doi.org/10.1016/j.jseint.2023.04.009 Text en © 2023 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Shoulder
Barrera, Lindsay
Sharareh, Behnam
Tamma, Poornima
Shah, Anup
Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title_full Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title_fullStr Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title_full_unstemmed Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title_short Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
title_sort total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position
topic Shoulder
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10328765/
https://www.ncbi.nlm.nih.gov/pubmed/37426922
http://dx.doi.org/10.1016/j.jseint.2023.04.009
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