NGỪNG TIM TRONG PHẪU THUẬT NỘI SOI KHỚP VAI TƯ THẾ NGỒI: BÁO CÁO CA LÂM SÀNG

Abstract

Beach chair position is commonly used in many procedures, especially in arthroscopic shoulder surgery, as it offers a number of distinct advantages over supine position, including providing better visualization and access to the anterior shoulder structures, reducing nerve injuries due to traction strain, and facilitating a transition to open surgery without the need for repositioning. However, this position is associated with the unstable hemodynamic risks such as hypotension, bradycardia, and cerebral hypoperfusion. The main cause of these disadvantages is the characteristic of the posture: the higher of elevated head and heart than the body, leading to a decrease in venous return, arterial blood pressure and cardiac output, which result in many dangerous complications such as prolonged hypotension, cerebral anemia, and even cardiac arrest. We report a clinical case of intraoperative cardiac arrest, a 66-year-old male patient undergoing arthroscopic shoulder surgery in the beach chair position. After changing position from supine to sitting position, his blood pressure dropped significantly. Despite being given fluids and Ephedrine, the blood pressure improved slowly. Immediately afterward, third-degree atrioventricular block, ventricular fibrillation, and then cardiac arrest appeared. We requested to stop the operation, put him back in a supine position, do CPR, give an electric shock, Adrenalin, and the heart would beat again after 10 minutes. The patient was ventilated for an additional 3 days and extubated when conditions allowed. He experienced psychosis after extubation, so he was treated with Haloperidol, and was discharged after 7 days. Through this clinical case, we would like to further analyze the mechanism and methods of preventing hemodynamic disorders in sitting surgery, helping anesthesiologists and surgeons have appropriate strategies to limit maximum cardiovascular complications during and after surgery.