The Effects of Positive-pressure Ventilation on Cerebral Oxygenation and Cardiac Output in Total Shoulder Arthroplasty.
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Cerebral Ischemia
- Sponsor
- Hospital for Special Surgery, New York
- Enrollment
- 34
- Locations
- 1
- Primary Endpoint
- Number of Cerebral Desaturation Events
- Status
- Completed
- Last Updated
- 3 years ago
Overview
Brief Summary
The purpose of this study is to measure cerebral oxygenation and cardiac output of total shoulder replacement patients undergoing general anesthesia (GA) and positive-pressure ventilation (PPV).
We hypothesize that cerebral desaturation occurs frequently during GA with PPV, but is rare during GA and spontaneous ventilation. We also hypothesize that cardiac output usually is well maintained under GA in the sitting position when epinephrine is used, but that decreased cardiac output increases the risk of cerebral desaturation.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Patients 18-99 undergoing total shoulder arthroplasty
- •Planned general anesthesia + brachial plexus nerve block
- •Planned arterial catheter
Exclusion Criteria
- •Patients younger than 18 years older and older than 99
- •Patients not intending to receive general anesthesia and peripheral nerve block
- •Indication for endotracheal tube
- •Ejection Fraction (if known) \< 50%
- •Known significant restrictive or obstructive pulmonary disease
- •Patients with a history of transient ischemic attack (TIA) or stroke
- •Patients with recent signs or symptoms of myocardial ischemia
- •Current stress test positive for ischemia
- •Intolerance to study medications
- •pre-existing contraindication to regional anesthesia
Outcomes
Primary Outcomes
Number of Cerebral Desaturation Events
Time Frame: Day of surgery
The number of Cerebral Desaturation Events (CDE) that occured. CDE is defined as a reduction in cerebral tissue oxygen saturation of \>20% from baseline that lasts for 90 seconds or longer.
Secondary Outcomes
- Stroke Volume (SV)(Day of surgery)
- Cardiac Output (CO)(Day of surgery)
- Cardiac Index (CI)(Day of surgery)
- End Tidal Carbon Dioxide (ETCO2)(Day of surgery)
- Intravenous Fluid Volume(Day of surgery)
- Mean Arterial Pressure (MAP)(Day of surgery)