title: Cerebral ischemia during shoulder surgery in the upright position: a case series.
abstract: We report 4 cases of ischemic brain and spinal cord injury after shoulder surgery in the beach chair position, using data from medical legal case reviews. We argue that the correlation between cardiovascular risk factors and cerebral ischemic complications for this type of surgery is poor in these middle-aged patients. Rather, our analysis suggests that the sitting position and the head position create specific physiological conditions that may be conducive to cerebral and spinal cord ischemia during this type of surgery. Thromboembolic events may be an additional cause of adverse neurologic outcomes.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Elizabeth's Medical Center, Boston, MA 02135, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Pohl
authors.forename: David J
authors.initials: DJ
authors.lastname: Cullen
mesh_terms: D000328:Adult; D019643:Arthroplasty, Replacement; D001182:Arthroscopy; D001926:Brain Death; D002545:Brain Ischemia / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D011187:Posture; D012307:Risk Factors; D017006:Rotator Cuff / Q000601:surgery; D012782:Shoulder / Q000601:surgery*; D012785:Shoulder Joint; D013119:Spinal Cord Injuries / Q000209:etiology