Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position

The beach-chair position in shoulder surgery provides advantages to the surgeon and anesthesiologist. However, cautious interpretation of the patient's blood pressure is essential, especially when the blood pressure cuff is placed at the calf. The calf pressure should be interpreted relative to the heart-level pressure to avoid iatrogenic cerebral hypoperfusion related to hypotensive anesthesia. Possible complications of cerebral hypoperfusion are permanent neurologic impairment, stroke, and death.