Practice Improvement by Implementing Cerebral Oximetry during Shoulder Surgery in the Beach Chair Position

Abstract

The beach chair position (BCP) is a reclined or sitting position at varying angles from 30-90° implemented for orthopedic shoulder arthroscopy and neurosurgical procedures. This position can lead to severe hemodynamic changes in the anesthetized patient due to marked decreases in cerebral blood flow (CBF) which increases the risk of cerebral tissue ischemia (Dippmann, Winge, & Nielsen, 2010). The use of cerebral oximetry during general anesthesia in the BCP allows the anesthesia provider to monitor brain tissue perfusion during all stages of anesthesia. Research indicates cerebral oximetry has the possibility of reducing postoperative complications, hospital length of stay, and allowing patients to quickly resume their activities of daily living (Abraham, 2014). The purpose of this Doctor of Nursing Practice (DNP) project was to identify barriers and evaluate the change in perceived benefit and implementation of cerebral oximetry for shoulder surgery in the BCP at a hospital in the Phoenix area. A pre and post-survey following an educational presentation identified barriers of implementing cerebral oximetry. Results from the post-survey revealed that 55.6% of providers (n=10) were not using cerebral oximetry even after the educational presentation on the benefits of this technology. On the post-survey, 89% of respondents (n=16) reported that they thought cerebral oximetry was potentially beneficial. Barriers to using cerebral oximetry were that cerebral oximetry was not available, 42% (n=18) or the provider did not have enough time to apply the monitor, 26% (n=11). Respondents also reported that surgeon interference, 14% (n=6) was a major barrier that prevented them from using cerebral oximetry. Results from this project show that anesthesia providers believe that cerebral oximetry may be beneficial to their patients but were limited in its implementation by several barriers.