THE ROLE OF NONINVASIVE CEREBRAL OXYGENATION MONITORING IN THE DETECTION OF CEREBRAL AUTOREGULATION IMPAIRMENT AND COGNITIVE DYSFUNCTION DURING ANESTHESIA IN THE BEACH CHAIR POSITION
DOI:
https://doi.org/10.15674/0030-59872026288-95Keywords:
Вeach chair position, cerebral autoregulation, hemodynamicAbstract
The beach chair position, commonly used in shoulder surgery, is associated with a potential risk of cerebral hypoperfusion due to hydrostatic gradient and anesthesia-induced hypotension. The role of cerebral autoregulation in maintaining adequate cerebral oxygenation under these conditions remains incompletely understood. Objective. Assess t he relationships b etween i ndicators of systemic hemodynamics, cerebral oximetry and cognitive functions in patients in the perioperative period in a beach chair position. Methods. A total of 80 patients were included. Mean arterial pressure (MAP), heart rate, and regional cerebral oxygen saturation were continuously monitored using near-infrared spectroscopy (NIRS). Cerebral autoregulation was assessed using the correlation between MAP and rSO2 (cerebral oximetry index, COx). Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA). Results. Preserved cerebral autoregulation was observed in 75 patients (93.75 %), who demonstrated no clinically significant decrease in rSO2 after positioning. Five patients (6.25 %) developed marked reductions in MAP and cerebral oxygenation. During surgery, the decrease in rSO2 was significantly greater in these patients compared with the preserved autoregulation group (–15.2 ± 4.6 % vs. –1.07 ± 4.79 %; p < 0.001). Postoperatively, the impaired autoregulation group showed a significant decline in MoCA scores from 28.4 ± 0.5 to 26.4 ± 0.5 points (p = 0.011), whereas cognitive performance remained unchanged in the remaining patients. Conclusions. Cerebral autoregulation remained preserved in most patients undergoing surgery in the beach chair position. Impaired cerebral autoregulation was associated with greater decreases in cerebral oxygenation and postoperative cognitive decline. NIRS monitoring may facilitate early identification of patients at risk of cerebral hypoperfusion and perioperative neurological complications.
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