Fluid preloading before beach chair positioning for arthroscopic shoulder procedures: a randomized controlled trial

Abstract

Background and objectives: The Beach Chair Position (BCP) has many advantages such as less neurovascular injury and better intra-articular visualization, but it has also negative consequences, including hemodynamic instability. Although maintaining normal Mean Arterial Pressure (MAP) is important, fluid management is also a crucial concept for hemodynamic stability. The main objective of this study is whether preloading before positioning would be effective for less hemodynamic instability.

Methods: This randomized, controlled study was conducted in a single center in the Istanbul University, Istanbul Faculty of Medicine. Forty-nine patients undergoing elective arthroscopic surgery in the BCP were recruited. In the study group, crystalloid fluid at 10...mL.kg^-1 of ideal body weight was administered intravenously 30...min before the BCP for preloading. The primary outcome measures were differences of hemodynamic variables as MAP, Stroke Volume (SV), Heart Rate (HR), and Cardiac Output (CO). The secondary outcome measures were Postoperative Nausea and Vomiting (PONV) rates in postoperative first day, surgical satisfaction scale, total ephedrine dose used during surgery, and total amount of fluid.

Results: The MAP, CO, and SV measurements of the study group were higher than those of the control group in the 5th minute after the BCP (respectively, p...=...0.001, p...=...0.016, p...=...0.01). The total amount of crystalloid and surgical satisfaction scales were higher in the study group (respectively, p...=...0.016, p...=...0.001). Total amount of colloid and ephedrine dose used in the intraoperative period, and PONV rates were lower in the study group (p...=...0.003, p...=...0.018, p...=...0.019, respectively).

Conclusion: Consequently, preloading can be favorable approach to preserve hemodynamic stability.

Keywords: Arthroscopic shoulder surgery; Beach chair position; Hemodynamic stability; Postoperative nausea and vomiting; Preloading.