Should the beach chair position have national guidelines to reduce the risk of cerebrovascular complications? Results from a National Survey of Surgeons and Anaesthetists

Background
The beach chair position is frequently used in UK shoulder surgeries, but cerebrovascular complications, while rare, can have severe consequences. No consensus exists on best practices due to limited evidence.

Methods
An online cross-sectional survey was conducted with a convenience sampling method among the British Elbow and Shoulder Society and Regional Anaesthesia UK members to gauge the need for guidelines. It aims to assess the need for standardised guidelines, covering topics such as demographics, current clinical practises in anaesthetics and surgery and the prevalence of cerebrovascular complications post-surgery.

Results
Of 534 respondents, 67% were anaesthetists and 33% surgeons. Twelve percent currently use local guidelines. 40% conduct all shoulder surgeries in the beach chair position. The most common bed angle is 45°, but 30% choose 60° or higher. 12.4% of respondents have local guidelines available. Only 20% of anaesthetists use cerebrovascular monitoring, with 6% of surgeons and 2% of anaesthetists reporting postoperative neurological issues. Eighty-five percent of respondents recommended the need for a national guidelines.

Conclusions
Current practices in the use of beach chair position vary considerably. There is a desire from both surgeons and anaesthetists for a consensus approach to guideline development based on current available evidence and practice.