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Bedeutung patientenspezifischer Risikofaktoren für die regionale zerebrale Sauerstoffsättigung in „Beach-chair“-Position

Significance of patient-specific risk factors for regional cerebral oxygen saturation in beach chair position

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Zusammenfassung

Hintergrund

Trotz zahlreicher Untersuchungen der zerebralen regionalen Sauerstoffsättigung (rSO2) mittels Nah-Infrarot-Spektroskopie (NIRS) an orthopädischen Patienten in Beach-chair-Position ist weiterhin unklar, ob patientenspezifische Faktoren wie kardiovaskuläre Begleiterkrankungen signifikant häufiger zum Auftreten pathologischer rSO2-Werte (zerebrale Desaturierungsereignisse, CDE) führen.

Ziel der Arbeit

Ziel der vorliegenden Studie war es, neben einer Identifikation möglicher patientenspezifischer Risikofaktoren zum ersten Mal auch eine Gewichtung dieser durchzuführen.

Material und Methoden

Insgesamt wurden 397 Patienten untersucht. Als CDE wurde eine Abnahme der rSO2 > 20 % oder ein Wert < 50 % definiert. Patienten ohne und mit CDE wurden hinsichtlich ihrer unterschiedlichen American Society of Anesthesiologists (ASA)- und Revised Cardiac Risk Index (RCRI)- Klassifikation sowie arteriellen Hypertonie und ihres Alters unterschieden. Zweifaktorielle Varianzanalysen (ANOVA) wurden durchgeführt.

Ergebnisse

Patienten mit CDE (n = 238) waren signifikant häufiger als ASA > 2 (p = 0,01) und RCRI > 1 (p = 0,01) klassifiziert, litten häufiger unter einem arteriellen Hypertonus (p = 0,01) und waren älter (Median [Jahre]: 60 vs. 55; p = 0,01) als Patienten ohne CDE (n = 159) in Beach-chair-Position. Eine arterielle Hypertonie war jeweils nach Entfernen des Effekts des Alters (p = 0,03) und der RCRI-Klassifikation (p = 0,04) weiterhin signifikant.

Fazit

Höheres Alter, ASA > 2, RCRI > 1 und v. a. ein arterieller Hypertonus konnten als Risikofaktoren bestimmt werden, die es bereits präoperativ ermöglichen, Patienten zu identifizieren, die gegenüber dem intraoperativen Auftreten von CDE in Beach-chair-Position besonders gefährdet sind.

Abstract

Background

Despite numerous studies on the regional cerebral oxygen saturation (rSO2) measured by near infrared spectroscopy (NIRS) in orthopedic patients in the beach chair position, it is still unclear whether patient-specific factors, such as concomitant cardiovascular diseases, are more frequently associated with the occurrence of cerebral desaturation events (CDE).

Objective

The aim of the present study was therefore to identify possible patient-specific risk factors that enable prediction of CDE.

Methods

Data were collected on 397 orthopedic patients undergoing shoulder surgery in the beach chair position. Routine anesthesia management and standard monitoring was used in all patients. Target value for the inspiratory oxygen concentration (FIO2) was set to 50% and for the end-tidal carbon dioxide partial pressure to 35–45 mm Hg. RSO2 was quantified using NIRS. The responsible anesthesiologist was blinded to the rSO2 data. A decrease in rSO2 > 20% or a value < 50% in the beach chair position was defined as CDE. Patients with and without CDE were analyzed with respect to different classifications, American Society of Anesthesiologists (ASA) and Revised Cardiac Risk Index (RCRI) as well as existing arterial hypertension and age. A value of p <0.05 was considered statistically significant.

Results

Patients with CDE (n = 238) were significantly more often classified as ASA > 2 (p = 0.01) and RCRI > 1 (p = 0.01), suffered more often from arterial hypertension (p = 0.01) and were older (median: 60 years compared to 55 years; p = 0.01) than patients without CDE (n = 159) in the beach chair position (Wilcoxon rank sum test). Arterial hypertension remained significant after removing the effect of age (p = 0.03) and RCRI classification (p = 0.04; two-way ANOVA multivariate analysis).

Conclusion

On the basis of our study, patient-specific prognosis and risk factors for the occurrence of CDE, such as higher age, ASA > 2 and RCRI > 1 classification as well as pre-existing arterial hypertension could be determined. Arterial hypertension represents the main risk factor for the occurrence of CDE in the beach chair position. RCRI > 1 classification or age, however, only has an effect on the occurrence of pathological rSO2 values due to the greater probability of simultaneous arterial hypertension.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, operative Intensivmedizin und Schmerztherapie, München Klinik Bogenhausen, Lehrkrankenhaus der technischen Universität München, Englschalkinger Straße 77, 81925, München, Deutschland

    Florian Fuchsgruber, Lisa Tölke & Patrick Friederich

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  1. Florian Fuchsgruber
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  2. Lisa Tölke
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Correspondence to Florian Fuchsgruber.

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Interessenkonflikt

F. Fuchsgruber, L. Tölke und P. Friederich geben an, dass kein Interessenkonflikt besteht.

Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Fuchsgruber, F., Tölke, L. & Friederich, P. Bedeutung patientenspezifischer Risikofaktoren für die regionale zerebrale Sauerstoffsättigung in „Beach-chair“-Position. Anaesthesist 71, 201–209 (2022). https://doi.org/10.1007/s00101-021-01014-6

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