The Cardiac Function in the Beach Chair Position under General Anesthesia

Background: Shoulder surgery is performed in the beach chair position (BCP). The systemic arterial blood pressure (BP) must be increased to prevent cerebral hypoperfusion. However, it is not clear how the cardiac function is affected when BP increase to maintain cerebral perfusion pressure in anesthetized patients. Methods: An analysis was performed using the data from 13 patients. We prepared a parallel circuit using a FloTrac Sensor transducer and an arterial BP transducer. Following the transfer of the patient to the BCP under general anesthesia, the FloTrac Sensor transducer was placed at the level of the fourth intercostal space, the arterial BP transducer was placed at the external auditory meatus level. We selected two points before surgery (120 s apart), during which the mean arterial BP (mABP) at the level of the brain was stable and at which the values in the supine position and the BCP were within 5 mmHg. Results: While the patients were in the supine position, the mean mABP at the mid-axillary level was 65.7 mmHg. In the BCP, the mean mABP was 66.5 mmHg at the external auditory meatus and 80.7 mmHg at the fourth intercostal space. The cardiac index changed from 2.2 (supine position) to 2.5 l/min/m2 (BCP). The stroke volume index was significantly increased from 35.8 to 42.3 ml/m2 (P = 0.003). The heart rate changed from 63.0 to 58.6 beats/min. The stroke volume variation was significantly decreased from 12.4% to 8.8% (P = 0.024). Conclusion: In order to ensure patient safety, close attention should be paid to the systemic cardiovascular changes that occur when the BP is increased.