Case of Cerebral Infarction during Shoulder Arthroscopy in the Beach-Chair Position

Abstract

A 63-year-old male underwent shoulder arthroscopy in the beach-chair position. The patient exhibited hypoactive emergence from general anesthesia and right hemiparesis was clearly present. His blood pressure（BP）was mostly maintained in the range of 80-96/50-65 mmHg during the operation, even though BP fell to 70/48 mmHg for several minutes. No remarkable findings were indicated in cranial CT/MRI and cerebrovascular angiography performed hours after surgery. However, extensive cortical infarction in the left hemisphere was confirmed through cranial MRI performed a week after surgery. Considering that the result of the cerebrovascular angiography showed no potential abnormalities, the cerebral infarction could have been initiated by low BP of short duration during the surgery. In conclusion, it is necessary to strictly avoid hypotension during procedures involving anesthesia for appropriate BP management.