5. Aortic Stenosis Patient | Shoulder Surgery, Beach Chair, Hemodynamics, Airway, Complications

In this episode of The Anesthesia Playbook, we walk through a real-world case of aortic stenosis anesthesia for a patient undergoing shoulder arthroplasty in the beach chair position.This case highlights the critical importance of hemodynamic management, myocardial oxygen supply and demand, and cerebral perfusion in patients with fixed outflow obstruction.We break down:How to manage aortic stenosis in the ORChoosing and performing an interscalene block + superficial cervical plexus blockAirway considerations including diabetic stiff joint syndrome and difficult intubationWhy phenylephrine is the pressor of choiceUnderstanding stroke volume, preload, afterload, and contractilityThe role of atrial kick and sinus rhythm in cardiac outputMyocardial ischemia from tachycardia and hypotensionRisks of the beach chair position, including cerebral hypoperfusionCerebral autoregulation and why chronic hypertension shifts the curveManaging Bezold-Jarisch reflex in shoulder surgeryThis episode is designed for anesthesia residents, CRNAs, and practicing anesthesiologists who want a clear, case-based understanding of complex physiology without memorizing textbooks.If you want to better understand how physiology applies in real cases and how to stay ahead of complications in the OR this episode is for you.