Cerebral oxygenation in patients undergoing shoulder surgery in beach chair position: comparing general to regional anesthesia and the impact on neurobehavioral outcome.

BACKGROUND: Ischemic brain damage has been reported in healthy patients after beach chair position for surgery due to cerebral hypoperfusion. Near-infrared spectroscopy has been described as a non-invasive, continuous method to monitor cerebral oxygen saturation. However, its impact on neurobehavioral outcome comparing different anesthesia regimens has been poorly described. METHODS: In this prospective, assessor-blinded study, 90 patients undergoing shoulder surgery in beach chair position following general (G-group, n=45) or regional anesthesia (R-group; n=45) were enrolled to assess the prevalence of cerebral desaturation events comparing anesthesia regimens and their impact on neurobehavioral and neurological outcome. Anesthesiologists were blinded to regional cerebral oxygen saturation values. Baseline data assessed the day before surgery included neurological and neurobehavioral tests, which were repeated the day after surgery. The baseline data for regional cerebral oxygen saturation/bispectral index and invasive blood pressure both at heart and auditory meatus levels were taken prior to anesthesia, 5 min after induction of anesthesia, 5 min after beach chair positioning, after skin incision and thereafter all 20 min until discharge. RESULTS: Patients in the R-group showed significantly less cerebral desaturation events (p<0.001), drops in regional cerebral oxygen saturation values (p<0.001), significantly better neurobehavioral test results the day after surgery (p<0.001) and showed a greater hemodynamic stability in the beach chair position compared to patients in the G-group. CONCLUSIONS: The incidence of regional cerebral oxygen desaturations seems to influence the neurobehavioral outcome. Regional anesthesia offers more stable cardiovascular conditions for shoulder surgery in beach chair position influencing neurobehavioral test results at 24h.

Analgesia durante el trabajo de parto y su influencia sobre el estado neuroconductual del recién nacido / Analgesia during labor and its influence on neurologic behavior condition of the newborn

Introducción: La analgesia peridural para el trabajo de parto, a pesar de sus detractores cobra adeptos cada día. Su repercusión sobre el neonato constituye uno de los puntos polémicos y controversiales. Objetivos: Evaluar en el recién nacido la repercusión de la analgesia durante trabajo de parto sobre su función neurológica y su posible relación con la forma de terminación del parto. Material y Método: Se realizó un estudio prospectivo a tres grupos de 25 neonatos. Las madres recibieron analgesia peridural lumbar continua (grupo A) o discontinua (grupo B). Se empleó una mezcla de bupivacaína y fentanyl. En el tercer grupo (C), las madres no recibieron tratamiento analgésico. A cada neonato se le realizó la evaluación neuroconductual de Amiel-Tisson. Resultados: El estado neuroconductual de los recién nacidos fue satisfactorio. Se mostró mínimas diferencias entre los tres grupos. La instrumentación del parto por analgesia epidural no afectó la evaluación neurológica de los neonatos. Conclusiones: La analgesia peridural para el trabajo de parto, no repercute negativamente sobre el recién nacido.

Introduction: Peridural anesthesia for labor, despite its detractors every day has more and more followers. Its repercussion on neonate is one of the controversial points. Objectives: To assess in newborn the repercussion of analgesia on neurologic function during labor and its possible relation with the way to finish it. Material and Methods: We made a prospective study in three groups of 25 neonates. Mothers had continuous lumbar peridural analgesia (group A) or intermittent (group B). We used a combination of Bupivacain and Fentanyl. In the third group mothers hadn't analgesic treatment. In each neonate we carried out a neurologic behavior assessment of Amiel-Tisson. Results: Neurologic behavior state of newborns was satisfactory. There were differences among the three groups. Birth instrumentation by epidural analgesia not affected t he neurologic assessment of neonates. Conclusions: Peridural analgesia for labor has not a negative repercussion on newborn.

Analgesia durante el trabajo de parto y su influencia sobre el estado neuroconductual del recién nacido / Analgesia during labor and its influence on neurologic behavior condition of the newborn

La analgesia peridural para el trabajo de parto, a pesar de sus detractores cobra adeptos cada día. Su repercusión sobre el neonato constituye uno de los puntos polémicos y controversiales. Evaluar en el recién nacido la repercusión de la analgesia durante trabajo de parto sobre su función neurológica y su posible relación con la forma de terminación del parto. Se realizó un estudio prospectivo a tres grupos de 25 neonatos. Las madres recibieron analgesia peridural lumbar continua (grupo A) o discontinua (grupo B). Se empleó una mezcla de bupivacaína y fentanyl. En el tercer grupo (C), las madres no recibieron tratamiento analgésico. A cada neonato se le realizó la evaluación neuroconductual de Amiel-Tisson. El estado neuroconductual de los recién nacidos fue satisfactorio. Se mostró mínimas diferencias entre los tres grupos. La instrumentación del parto por analgesia epidural no afectó la evaluación neurológica de los neonatos. La analgesia peridural para el trabajo de parto, no repercute negativamente sobre el recién nacido(AU)

Peridural anesthesia for labor, despite its detractors every day has more and more followers. Its repercussion on neonate is one of the controversial points. To assess in newborn the repercussion of analgesia on neurologic function during labor and its possible relation with the way to finish it. We made a prospective study in three groups of 25 neonates. Mothers had continuous lumbar peridural analgesia (group A) or intermittent (group B). We used a combination of Bupivacain and Fentanyl. In the third group mothers hadn't analgesic treatment. In each neonate we carried out a neurologic behavior assessment of Amiel-Tisson.Neurologic behavior state of newborns was satisfactory. There were differences among the three groups. Birth instrumentation by epidural analgesia not affected t he neurologic assessment of neonates. Peridural analgesia for labor has not a negative repercussion on newborn(AU)