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Abutalib RA, Alamri AJ, Aqel SA, Alhumaidi IM, Almohini IA. Acute Respiratory Distress and Hyperchloremic Metabolic Acidosis as a Result of Massive Irrigation Fluid Extravasation After Arthroscopic Shoulder Surgery: A Case Report and Recommendations for Preventable Complications. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926357. [PMID: 33184253 PMCID: PMC7672508 DOI: 10.12659/ajcr.926357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patient: Female, 68-year-old Final Diagnosis: Pleural effusion Symptoms: Breathlessness • shortness of breath Medication: — Clinical Procedure: Arthroscopic Rotator Cuff repair Specialty: Orthopedics and Traumatology
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Affiliation(s)
- Raid A Abutalib
- Department of Orthopedic Surgery, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Asim J Alamri
- Department of Orthopedic Surgery, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Samir A Aqel
- Department of Orthopedic Surgery, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Ibrahim M Alhumaidi
- Department of Orthopedic Surgery, Prince Mohammed Bin Abdulaziz Hospital, Almadinah Almunawwarah, Saudi Arabia
| | - Ibrahim A Almohini
- Department of Orthopedics, College of Medicine, King Saud Bin Abdulaziz University of Health Sciences, Riyadh, Saudi Arabia
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Rojas J, Familiari F, Bitzer A, Srikumaran U, Papalia R, McFarland EG. Patient Positioning in Shoulder Arthroscopy: Which is Best? JOINTS 2019; 7:46-55. [PMID: 31879731 PMCID: PMC6930847 DOI: 10.1055/s-0039-1697606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/06/2019] [Indexed: 11/24/2022]
Abstract
When performing diagnostic and surgical arthroscopic procedures on the shoulder, the importance of patient positioning cannot be understated. The optimum patient positioning for shoulder arthroscopy should enhance intraoperative joint visualization and surgical accessibility while minimizing potential perioperative risk to the patient. Most shoulder arthroscopy procedures can be reliably performed with the patient either in the lateral decubitus (LD) or beach chair (BC) position. Although patient positioning for shoulder arthroscopy has been subject of controversy, there is no conclusive evidence to suggest superiority of one position versus another. Each position offers advantages and disadvantages and surgeon's experience and training are pivotal on selecting one position versus another. Regardless of the position, a proper positioning of the patient should provide adequate access to the joint while minimizing complications. The purpose of this review is to summarize setup and technical aspects, the advantages and disadvantages, and the possible complications of the LD and BC positions in shoulder arthroscopy.
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Affiliation(s)
- Jorge Rojas
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Villa del Sole" Clinic, Catanzaro, Italy
| | - Alexander Bitzer
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Uma Srikumaran
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
| | - Rocco Papalia
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Edward G McFarland
- Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States
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Vier BR, Mombell KW, Gagliano EL, King NM, McDonald LS. Extravasation of fluid in arthroscopic shoulder surgery requiring prolonged intubation: a case report. Patient Saf Surg 2019; 13:21. [PMID: 31205484 PMCID: PMC6560911 DOI: 10.1186/s13037-019-0202-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
Background Shoulder arthroscopy is a safe and effective procedure with a low complication rate. Although rare, there are potentially life-threatening risks such as fluid extravasation causing airway compromise. Case presentation We report the case of a 65-year-old female treated with an arthroscopic rotator cuff repair who had significant extravasation of arthroscopic fluid causing severe facial and neck swelling. Overnight intubation was required for respiratory monitoring until the edema had resolved enough to allow safe extubation. Conclusion This case highlights the risk factors and clinical course of a patient with airway compromise caused by extravasation of fluid during shoulder arthroscopy. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment.
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Affiliation(s)
- Brandon R Vier
- 1Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA USA
| | - Kyle W Mombell
- 1Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA USA
| | - Erin L Gagliano
- 2Department of Anesthesia, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA USA
| | - Nicole M King
- 2Department of Anesthesia, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA USA
| | - Lucas S McDonald
- 1Department of Orthopedic Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA USA
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Memon M, Kay J, Gholami A, Simunovic N, Ayeni OR. Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review. Orthop J Sports Med 2018; 6:2325967118771616. [PMID: 29785406 PMCID: PMC5954585 DOI: 10.1177/2325967118771616] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Arthroscopic surgery of the shoulder joint has become increasingly more common given its advantages over open surgery; however, one rare but potentially life-threatening complication is fluid extravasation into the surrounding tissues, causing edema, respiratory compromise, abnormal results on laboratory blood tests, and possibly death. Currently, no systematic review exists that summarizes the existing clinical research on this topic. Purpose To perform a systematic review on fluid extravasation as a complication of shoulder arthroscopic surgery, specifically assessing clinical presentation, risk factors, management, and outcomes. Study Design Systematic review; Level of evidence, 4. Methods Two reviewers independently searched 3 databases (PubMed, Ovid [MEDLINE], and Embase) from database inception until July 1, 2017. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction. The methodological quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. The results are presented in a narrative summary fashion using descriptive statistics including ranges and agreement statistics. Results A total of 26 studies (20 case reports, 4 case series, and 2 prospective comparative studies) encompassing 205 patients (mean age, 50.8 years [range, 15-83 years]) were included. The most common signs of fluid extravasation included chest wall swelling (n = 86) and neck swelling (n = 116). In 32 patients, observation alone was sufficient. Other patients required airway intubation (n = 16), diuretics (n = 7), steroids (n = 1), and percutaneous drainage of fluid (n = 1). Clinical edema resolved after 2 to 48 hours, and patients were discharged 1 to 20 days postoperatively. Serious complications included transfer to the intensive care unit (n = 14), anterior interosseous nerve palsy (n = 4), rhabdomyolysis (n = 1), and death (n = 1). Conclusion Fluid extravasation has the potential to be a life-threatening complication of shoulder arthroscopic surgery; however, it is most commonly managed nonoperatively, and symptoms typically resolve with no evidence of long-term complications. Intraoperative surgical decisions, such as minimizing the surgical time and volume of irrigation fluid used, may limit fluid extravasation, while careful intraoperative monitoring may facilitate prompt diagnosis and management to optimize patient outcomes.
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Affiliation(s)
- Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arian Gholami
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- Investigation performed at McMaster University, Hamilton, Ontario, Canada
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Gupta S, Manjuladevi M, Vasudeva Upadhyaya KS, Kutappa AM, Amaravathi R, Arpana J. Effects of irrigation fluid in shoulder arthroscopy. Indian J Anaesth 2016; 60:194-8. [PMID: 27053783 PMCID: PMC4800936 DOI: 10.4103/0019-5049.177866] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Extravasation of irrigation fluid used in shoulder arthroscopy can lead to life-threatening airway and systemic complications. This study was conducted to assess the effect of irrigation fluid absorption on measurable anthropometric parameters and to identify whether these parameters predict airway/respiratory compromise. METHODS Thirty six American Society of Anaesthesiologists physical status one or two patients aged 15-60 years undergoing shoulder arthroscopy under general anaesthesia were recruited. Measured variables preoperatively (baseline) and at the end of surgery were neck, chest, midarm and midthigh circumferences, weight, haemoglobin and serum sodium. Temperature, endotracheal tube cuff pressure, airway pressure, duration of surgery, amount of irrigation fluid and intravenous fluid used were also noted. Measured parameters were correlated with the duration of surgery and the amount of irrigation fluid used. RESULTS Postoperatively, the changes in variables showed a significant increase in the mean values (cm) for neck, chest, midarm and midthigh circumference (mean ± standard deviation: 2.35 ± 1.9, P < 0.001; 2.9 ± 3.88 cm, P < 0.001; 3.28 ± 2.44, P < 0.001 and 0.39 ± 0.71, P = 0.002, respectively) and weight (kg) (1.17 ± 1.24, P < 0.001). The post-operative haemoglobin (g/dL) levels decreased significantly (0.89 ± 1.23, P < 0.001) as compared to the baseline. No significant change was found in the serum sodium levels (P = 0.92). No patient experienced airway/respiratory compromise. CONCLUSION Regional and systemic absorption of irrigation fluid in arthroscopic shoulder surgery is reflected in the degree of change in the measured anthropometric variables. However, this change was not significant enough to cause airway/respiratory compromise.
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Affiliation(s)
- Surbhi Gupta
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
| | - M Manjuladevi
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
| | - K S Vasudeva Upadhyaya
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
| | - A M Kutappa
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
| | - Rajkumar Amaravathi
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
| | - J Arpana
- Department of Anaesthesiology and Critical Care, St. John's Medical College and Hospital, Johnnagara, Koramangala, Bangalore, Karnataka, India
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Edwards DS, Davis I, Jones NA, Simon DW. Rapid tracheal deviation and airway compromise due to fluid extravasation during shoulder arthroscopy. J Shoulder Elbow Surg 2014; 23:e163-5. [PMID: 24929747 DOI: 10.1016/j.jse.2014.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 03/19/2014] [Accepted: 03/20/2014] [Indexed: 02/01/2023]
Affiliation(s)
- Dafydd S Edwards
- Department of Trauma and Orthopaedics, Basingstoke Hospitals, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK.
| | - Ian Davis
- Department of Trauma and Orthopaedics, Basingstoke Hospitals, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Nick A Jones
- Department of Trauma and Orthopaedics, Basingstoke Hospitals, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
| | - Dominic W Simon
- Department of Trauma and Orthopaedics, Basingstoke Hospitals, Hampshire Hospitals NHS Foundation Trust, Basingstoke, Hampshire, UK
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No MY, Kim PO, Choi WJ. Airway compression after arthroscopic shoulder surgery under general anesthesia. Korean J Anesthesiol 2014; 65:S121-2. [PMID: 24478840 PMCID: PMC3903828 DOI: 10.4097/kjae.2013.65.6s.s121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Min-Young No
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Pyoung-On Kim
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
| | - Won-Jun Choi
- Department of Anesthesiology and Pain Medicine, Sungkyunkwan University School of Medicine, Kangbuk Samsung Hospital, Seoul, Korea
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Khan F, Padmanabha S, Shantaram M, Aravind M. Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy. J Anaesthesiol Clin Pharmacol 2013; 29:578-9. [PMID: 24250015 PMCID: PMC3819872 DOI: 10.4103/0970-9185.119171] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ferhan Khan
- Department of Anesthesiology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India
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Sulaiman L, Macfarlane RJ, Waseem M. Current concepts in anaesthesia for shoulder surgery. Open Orthop J 2013; 7:323-8. [PMID: 24082970 PMCID: PMC3785039 DOI: 10.2174/1874325001307010323] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 10/06/2012] [Accepted: 11/24/2012] [Indexed: 12/16/2022] Open
Abstract
There has been an exponential growth in the volume of shoulder surgery in the last 2 decades and a very wide variety of anaesthetic techniques have emerged to provide anaesthesia and post-operative analgesia. In this article we examine current opinion, risks, benefits and practicalities of anaesthetic practice and the provision of post-operative analgesia for shoulder surgery.
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Affiliation(s)
- Lutfi Sulaiman
- East Cheshire NHS Trust, Victoria Rd, Macclesfield, SK10 3BL, UK
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Affiliation(s)
- Mouveen Sharma
- Department of Anaesthesiology, Kasturba Medical College, Manipal, Karnataka, India
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Gwak MS, Kim WH, Choi SJ, Lee JJ, Ko JS, Kim GS, Kim YI, Kim MH. Arthroscopic shoulder surgery under general anesthesia with brachial plexus block: postoperative respiratory dysfunction of combined obstructive and restrictive pathology. Anaesthesist 2013; 62:113-20. [PMID: 23400711 DOI: 10.1007/s00101-012-2125-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/04/2012] [Accepted: 12/10/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Changes in respiratory parameters and pulmonary function tests were evaluated after shoulder arthroscopic surgery with brachial plexus block (BPB). The purpose of this study was to identify the mechanism of respiratory dysfunction after this type of surgery. METHODS Patients undergoing arthroscopic rotator cuff repair under general anesthesia (GA) with BPB were enrolled in the arthroscopy group (n = 30) while those undergoing open reduction of a clavicle or humerus fracture under GA were enrolled in the control group (n = 30). Forced vital capacity (FVC) and forced expiratory volume 1 s (FEV(1)) were measured at the outpatient clinic stage (#1) before (#2) and 20 min after BPB (#3) and 1 h after extubation (#4). Respiratory variable measurements along with the cuff leak test were performed 5 min after surgical positioning (T1) and at the start of skin closure (T2). Respiratory discomfort was evaluated after extubation. The upper airway diameters and soft tissue depth of chest wall were also measured by ultrasonography at stages #3 and #4. RESULTS Static compliance decreased significantly at T2 in the arthroscopy group (50 ± 11 at T1 vs. 44 ± 9 ml/cm H(2)O at T2, p =0.035) but not in the control group. The incidence of positive cuff leak tests at T2 was significantly higher in the arthroscopy group than in the control group (47% in the arthroscopy group vs. 17% in controls, p =0.010). While FEV(1) and FVC remained stable at stages #1 and #2, FVC and FEV(1) decreased at stages #3 and #4 only in the arthroscopy group (FVC in arthroscopy group, #2: 3.26 ± 0.77 l; #3: 2.55 ± 0.63 l, p =0.015 vs. #2; #4: 2.66 ± 0.41 l, p =0.040 vs. #2). The subglottic diameter decreased at #4 in the arthroscopy group, while no changes occurred in the control group (0.70 ± 0.21 cm vs. 0.85 ± 0.23 cm in the arthroscopy and control groups, respectively, p =0.011). Depth of skin to pleura increased at both intercostal spaces 1-2 and 3-4 in the arthroscopy group. There were three cases of hypoxia (S(p)O(2) < 95%) with room air in the arthroscopy group while none occurred in the controls. CONCLUSION Shoulder arthroscopic surgery under GA with BPB induced both restrictive and obstructive pathologies. It is important to maintain a high level of awareness for the potential negative respiratory effects of this surgery especially for subjects with pre-existing cardiopulmonary disease. The measurements in this study would be useful to monitor the risk of respiratory dysfunction in these patients.
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Affiliation(s)
- M S Gwak
- Department of Anesthesiolgy and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-Dong, 135-710, Seoul, Republic of Korea
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Gogia AR, Bajaj J, Sahni A, Saigal D. Negative-pressure pulmonary oedema in a patient undergoing shoulder arthroscopy. Indian J Anaesth 2012; 56:62-5. [PMID: 22529423 PMCID: PMC3327075 DOI: 10.4103/0019-5049.93347] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
An 18-year-old ASA-I patient who underwent elective left shoulder arthroscopy developed severe airway obstruction post-extubation due to fluid extravasation from the shoulder joint into the neck and airway tissue. Re-intubation for relief of obstruction resulted in negative-pressure pulmonary oedema. The patient was electively ventilated in the intensive care unit and recovered uneventfully. A high index of suspicion along with monitoring of neck circumference can prevent this kind of complication.
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Affiliation(s)
- Anoop Raj Gogia
- Department of Anaesthesia and Intensive Care, Safdarjung Hospital and Vardhaman Mahavir Medical College, New Delhi, India
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Errando CL. Ultrasound observation of tissue fluid infiltration causing stridor in a woman undergoing shoulder arthroscopy. ACTA ACUST UNITED AC 2012; 58:582-4. [PMID: 22279878 DOI: 10.1016/s0034-9356(11)70143-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Respiratory stridor developed rapidly during an interscalene brachial plexus block for shoulder arthroscopy in an obese woman. Extensive cervicothoracic edema due to tissue diffusion of the arthroscopic fluid was suspected. The outcome of patient after conservative management was satisfactory. We give a brief review of how this complication develops, the ultrasound findings, and briefly discuss similar cases.
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Affiliation(s)
- C L Errando
- Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario de Valencia, Valencia.
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Ozhan MO, Suzer MA, Cekmen N, Caparlar CO, Eskin MB. Tracheal compression during shoulder arthroscopy in the beach-chair position. CURRENT THERAPEUTIC RESEARCH 2010; 71:408-15. [PMID: 24688159 PMCID: PMC3969593 DOI: 10.1016/s0011-393x(10)80006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Respiratory distress is a rare complication of outpatient shoulder arthroscopy and mostly associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis. OBJECTIVE We report on a shoulder arthroscopy complicated by tracheal compression caused by extravasation of irrigation fluid into soft tissues of the upper airway while the patient was in the beach-chair position under general anesthesia. CASE SUMMARY A 33-year-old male was scheduled for shoulder arthroscopy for impingement syndrome of the right shoulder under general anesthesia combined with interscalene brachial plexus block. During the operation, the patient's neck, right chest, and shoulder were observed to be swollen and tense on palpation. A fiberoptic bronchoscopic evaluation through the endotracheal tube revealed that the trachea was compressed to the left, but not completely obstructed. It was determined that the irrigation fluid had leaked subcutaneously from the shoulder joint to the neck. Vital signs were stable and the patient could be adequately ventilated despite the airway obstruction. The patient was transferred to the ward 16 hours after the operation with stable vital signs and discharged from the hospital on the second day. CONCLUSIONS We report a case of airway obstruction due to tracheal compression from extravasation of irrigation fluid during shoulder arthroscopy under general anesthesia combined with peripheral nerve block in the beach-chair position. General anesthesia with endotracheal intubation protected the patient from a possibly fatal complication.
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Affiliation(s)
- Mehmet Ozgur Ozhan
- Department of Anesthesiology and Reanimation, Mayis Hospital, Ankara, Turkey
| | - Mehmet Anil Suzer
- Department of Anesthesiology and Reanimation, Mayis Hospital, Ankara, Turkey
| | - Nedim Cekmen
- Department of Anesthesiology and Reanimation, Guven Hospital, Ankara, Turkey
| | - Ceyda Ozhan Caparlar
- Department of Anesthesiology and Reanimation, Ministry of Health Van Hospital, Van, Turkey
| | - Mehmet Burak Eskin
- Department of Anesthesiology and Reanimation, Gulhane Medical Faculty, Ankara, Turkey
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Venkat G, Moon YL, Na WC, So KY. Upper airway compromise by extravasated fluid: a rare complication after arthroscopic repair of atrophic cuff tear. Orthopedics 2009; 32:orthopedics.43785. [PMID: 19824592 DOI: 10.3928/01477447-20090818-32] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
During arthroscopic procedures, leakage of irrigation fluid into surrounding tissue planes is a frequently noticed phenomenon usually clinically asymptomatic and resolving within 12 hours postoperatively. Although rare, this fluid may produce life-threatening complications such as airway compromise. This article describes a case of upper airway obstruction in a 60-year-old man undergoing arthroscopic repair for an atrophic rotator cuff tear. The patient presented with a 6-month history of pain and weakness in the left shoulder. Magnetic resonance imaging studies revealed a massive rotator cuff tear with significant retraction and fatty degeneration of cuff musculature. Perioperatively, all vital cardiorespiratory parameters were within normal limits. Postoperatively, immediately on extubation, he was dyspneic, and examination revealed a diffuse swelling extending from the left shoulder up to the neck and face. He was reintubated and sent to the recovery room, where he recovered 12 hours later. This article highlights the possibility of respiratory compromise due to the extravasation of irrigation fluid into the neck and chest during arthroscopic repair of massive and atrophied cuff tears, even with shorter surgical time as is this case. The widened suprascapular space will offer less resistance to the spread of fluid into the neck and chest from the shoulder. We advocate monitoring the patient continuously to prevent this serious complication from becoming life-threatening.
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Moon YL, Yu BS, So KY, Lim KJ, Kang JH. Life-threatening Airway Edema after Arthroscopic Repair of Massive Rotator Cuff Tear - A Case Report -. Clin Shoulder Elb 2007. [DOI: 10.5397/cise.2007.10.1.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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