ANAESTHESIA FOR SHOULDER SURGERY IN THE STEEP “BEACH CHAIR” POSITION: IS IT SAFE?
T F Little
Melbourne Anaesthetic Group, Melbourne, VIC
A clinical report of visual loss and ophthalmoplegia following shoulder surgery in the upright beach chair position and a more recent report of four cases of cerebral and spinal cord ischaemia, extracted from medico legal case reviews, have reignited concerns about this technique. Subsequent to a widely publicised case in the Supreme Court of Victoria (2001) in which a 53 year old healthy woman was left with global cerebral ischaemia after a routine sub-acromial decompression, many anaesthetists have refused to participate in this procedure and at least one public hospital recently issued a blanket ban on anaesthesia for surgery in this position. Whilst not all surgeons are comfortable operating in this steep upright position, those who perform the technique argue that there are significant surgical advantages. To many anaesthetists not familiar with the steep beach chair position it may present a dilemma. Not only are the common factors of hypotension and potential air embolism present but also problems of positioning, accessibility and monitoring. Since the issue has major clinical and medico legal implications, this review will examine the physiological changes inherent in assuming the beach chair position, the contribution of interscalene plexus brachial plexus block and adaptations to technique to eliminate any identifiable risk factors.
Time of Presentation
Sunday 14 May 2006 - 1030-1200
