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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| Format: | Article |
| Language: | English |
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Elsevier
2023-07-01
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| Series: | JSES International |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638323001159 |
| _version_ | 1797796102854934528 |
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| author | Lindsay Barrera, MD Behnam Sharareh, MD Poornima Tamma, BS Anup Shah, MD |
| author_facet | Lindsay Barrera, MD Behnam Sharareh, MD Poornima Tamma, BS Anup Shah, MD |
| author_sort | Lindsay Barrera, MD |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-03-13T03:28:07Z |
| format | Article |
| id | doaj.art-322fea8bb5d84cde846709fc6ab47c62 |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-03-13T03:28:07Z |
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| spelling | doaj.art-322fea8bb5d84cde846709fc6ab47c622023-06-25T04:44:01ZengElsevierJSES International2666-63832023-07-0174648652Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair positionLindsay Barrera, MD0Behnam Sharareh, MD1Poornima Tamma, BS2Anup Shah, MD3Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USA; Corresponding author: Lindsay Barrera, MD, Department of Orthopedic Surgery, Baylor College of Medicine, 7200 Cambridge Street, Ste. 10A, Houston, TX 77030, USA.Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX, USASchool of Medicine, Baylor College of Medicine, Houston, TX, USAUniversity of Arizona College of Medicine, Phoenix Banner University Medical Group, Phoenix, AZ, USABackground: 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.http://www.sciencedirect.com/science/article/pii/S2666638323001159Total intravenous anesthesiaGeneral anesthesiaShoulder arthroscopyBeach chair position |
| spellingShingle | Lindsay Barrera, MD Behnam Sharareh, MD Poornima Tamma, BS Anup Shah, MD Total intravenous anesthesia compared to traditional general anesthesia in shoulder arthroscopy with interscalene block in the beach chair position JSES International Total intravenous anesthesia General anesthesia Shoulder arthroscopy 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 | Total intravenous anesthesia General anesthesia Shoulder arthroscopy Beach chair position |
| url | http://www.sciencedirect.com/science/article/pii/S2666638323001159 |
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