Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position: a randomized controlled trial

Abstract

Background: The beach-chair position (BCP) results in decreases in venous return, cardiac output, and cerebral perfusion pressure. In this randomized, prospective study, we investigated whether applying thigh-high compression stockings affected the maintenance of regional cerebral tissue oxygen saturation (rSO₂) in the BCP.

Methods: Patients undergoing orthopedic surgery in the BCP under general anesthesia were included and assigned randomly to the control or the compression stocking group. Appropriately sized thigh-high compression stockings were applied to the patients in the stockings group. All patients were tilted, up to 45°, throughout the operation. Non-invasive blood pressure, invasive arterial blood pressure zeroed at the external auditory meatus, and rSO₂ were recorded.

Results: Data were analyzed from 19 patients per group. In the BCP, the values of rSO₂ and blood pressure decreased significantly compared with those at baseline, with no significant difference between the groups. The incidences of cerebral desaturation events (CDEs) were similar between the groups; however, that of hypotension was significantly lower in the compression stocking group. During 36 CDEs, the levels of rSO₂ and blood pressure decreased significantly compared with those at baseline in both groups. No significant correlation was found between rSO₂ and blood pressure.

Conclusions: Thigh-high compression stockings reduced the incidence of hypotension but not that of CDEs. Our results suggest that other factors, beyond hypotension itself, contribute to CDEs and in other words, efforts just to reduce the incidence of hypotension may not mainly contribute to a reduction of CDEs occurrence in the BCP under general anesthesia.

Keywords: Beach chair position; Cerebral perfusion pressure; Compression stockings; Hypotension; Near-infrared spectroscopy; Shoulder surgery.

Fig. 1.

Consolidated standards of reporting trials (CONSORT) flow chart.

Fig. 2.

Correlations between (A) NIBP and rSO₂, (B) eABP and rSO₂, and (C) NIBP and eABP. During 36 cerebral desaturation event episodes, no significant correlation was found between NIBP and rSO₂ (P = 0.224) or between eABP and rSO₂ (P = 0.139), while there was a significant correlation between NIBP and eABP (P < 0.001). rSO₂: regional cerebral tissue oxygen saturation, NIBP: non-invasive blood pressure, eABP: invasive arterial blood pressure zeroed at the external auditory meatus.