Learning objectives

• Describe the advantages and risks of the beach chair position
• Manage patients presenting for surgery in the beach chair position

Background

• Patients are often positioned in the beach chair or sitting position for shoulder surgery, fossa craniotomy, and post-c-spine surgery

Advantages

• Improved surgical access
• Decreased brachial traction injury
• Ease of setup and conversion to an open approach
• Decreased risk of bleeding

Risks

• Hypotension
• Decrease in cerebral perfusion
• Venous air embolism
• Paradoxical air embolism
• Excessive neck flexion
• Bradycardia or cardiac arrest
• Macroglossia
• Upper airway obstruction
• Pneumocephalus
• Subdural hematoma
• Quadriplegia
• Stroke

Management

Management of patients presenting for surgery in the beach chair position comprises minimizing the risk of complications, mainly by maintaining cerebral perfusion.

Before positioning the patient, review the risks.
Beach chair management in the Anesthesia Assistant App.

Suggested reading

• Murphy GS, Greenberg SB, Szokol JW. Safety of Beach Chair Position Shoulder Surgery: A Review of the Current Literature. Anesth Analg. 2019;129(1):101-118.
• Hewson DW, Oldman M, Bedforth NM. Regional anaesthesia for shoulder surgery. BJA Education. 2019;19(4):98-104.
• Rozet I, Vavilala MS. Risks and benefits of patient positioning during neurosurgical care. Anesthesiol Clin. 2007;25(3):631-x.

Clinical Updates

Cohen-Balaloum et al. (Regional Anesthesia and Pain Medicine, 2026) report that in 482 patients undergoing shoulder arthroscopy in the beach-chair position, regional anesthesia alone was associated with markedly less intraoperative hypotension than combined general and regional anesthesia. RA alone was also associated with substantially less vasopressor use, shorter PACU stay, and more frequent same-day discharge, supporting RA-only techniques as a potentially hemodynamically advantageous strategy in appropriately selected patients, while recognizing the study’s retrospective single-center design. 

• Read more about this study HERE.