Cerebral tissue oxygen saturation during arthroscopic shoulder surgery in the beach chair and lateral decubitus position

Arthroscopic shoulder surgery is a common procedure and can be performed with the patient in the lateral decubitus position (LDP) or beach chair position (BCP). Although the BCP is associated with better visualization and less bleeding, it has also been associated with hemodynamic changes and consequently cerebral hypoperfusion. Devastating events reported after surgery in the BCP were attributed to a combination of the upright position and hypotension. Besides position and blood pressure, ventilator management and type of anesthesia should be taken into account. Near infrared spectroscopy might be able to provide an early warning sign of cerebral hypoperfusion during shoulder surgery in the BCP. It was therefore recommended to continuously monitor cerebral oxygenation in patients undergoing shoulder surgery in the BCP, to potentially prevent devastating outcomes. However, more clinical research on the safe lower limits of cerebral tissue oxygen saturation is needed for this recommendation to gain broad acceptance.