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Beach Chair Position: Advantages, Risks, and Management

Introduction

During surgery in the beach chair position under general anesthesia, there is wide variability in the lower limit of cerebral autoregulation. This post explores the advantages and risks of the beach chair position and provides guidance on managing patients presenting for surgery in this position.

Advantages

• Improved venous drainage from the head and neck
• Reduced intracranial pressure
• Improved surgical exposure to the posterior fossa
• Decreased risk of air embolism

Risks

• Cerebral ischemia due to impaired cerebral autoregulation
• Venous air embolism
• Brachial plexus injury
• Ulnar nerve palsy
• Cervical spine injury

Management

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Monitor cerebral perfusion pressure and adjust anesthesia accordingly

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Pad all pressure points, including the head, neck, shoulders, and elbows

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Use a shoulder roll to support the shoulders and prevent brachial plexus injury

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Elevate the patient's legs to prevent venous pooling

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Avoid excessive neck flexion or extension

Complications

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Cerebral ischemia

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Venous air embolism

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Brachial plexus injury

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Ulnar nerve palsy

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Cervical spine injury

The beach chair position is a useful surgical position that can provide several advantages. However, it is associated with certain risks that must be managed properly. By following the recommendations outlined in this post, clinicians can safely use the beach chair position to improve patient outcomes.

Author: Associate Professor Senior Associate Chair of Clinical Affairs and Quality, University of Michigan Medical School Ann Arbor

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