Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy

Khan, Ferhan; Padmanabha, S; Shantaram, Manjula; Aravind, M

doi:10.4103/0970-9185.119171

Cited by 11 publications

(18 citation statements)

References 6 publications

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“…22 Further, the use of irrigation pump devices may be eliminated entirely and replaced by gravity-driven irrigation systems to limit irrigation fluid pressures. 22 Operative techniques that may reduce the inadvertent spread of irrigation fluid to the extra-articular space include the use of longer cannulas to prevent dislodging, avoiding the use of cannulas entirely and using the arthroscope itself for inflow, 25,26 minimizing capsular rents, and allowing low continuous outflow so that fluid can exit the subacromial space. 14,26 Finally, while it is believed that the lateral decubitus position increases the risk for fluid extravasation, the beach-chair position carries its own risks, of particular concern for anesthesiologists, including the risk of air embolism, hypotension, bradycardia, and central nervous system ischemia.…”

Section: Discussionmentioning

confidence: 99%

Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

Memon

Kay

Gholami

et al. 2018

Orthopaedic Journal of Sports Medicine

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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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Section: Discussionmentioning

confidence: 99%

Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

Memon

Kay

Gholami

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…[ 7 8 9 ] Literature describes cases where patients developed facial and neck oedema, laryngeal oedema and extensive swelling across the chest, during shoulder arthroscopy under general/regional anaesthesia. [ 10 11 12 13 ] The patients had to be re-intubated and mechanically ventilated postoperatively. We reported three cases from our institution where patients had to be re-intubated, electively ventilated and monitored in the Intensive Care Unit following shoulder arthroscopy.…”

Section: Discussionmentioning

confidence: 99%

Effects of irrigation fluid in shoulder arthroscopy

et al. 2016

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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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“…[ 23 ] However, in order to limit the high pressure by the device, irrigation pump powered by gravity is recommended. [ 24 ] All the irrigation water were placed on the same level and pumped by gravity in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies showed the duration of this surgery should be less than 120 minutes. [ 24 ] The critical value of operative time to lead airway compromise is about 150 minutes. [ 33 ] As a result, risk can be reduced by decreasing the operation time.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary edema following shoulder arthroscopy under general anesthesia with nerve block

et al. 2020

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Shoulder arthroscopy requires a large of irrigation for a better surgical view, leading circulatory overload. This study was performed to prove whether pulmonary edema will be lead by a large of irrigation. General anesthesia with interscalene block was induced before operation. The primary outcome was ultrasound evaluation of B lines from the time before nerve block to the time 10 hours after operation. The secondary outcomes included oxygenation index, arterial partial pressure of carbon dioxide, visual analogue scale, muscle strength grade. A total of 93 patients were evaluated. Before surgery, B lines failed to be detected. While the highest total incidence of B lines was 49.4%, occurred at 4 hours after surgery. The highest incidences of severe and moderate pulmonary edema were 3.2% ( P = .081) and 9.7% ( P = .002), respectively. B lines were also found on both the affected and healthy side. During operation, the incidence of type 1 respiratory failure was 5.4% ( P = .023) and that of both type 1 and 2 respiratory failure were 6.5% ( P = .013). Pain was relieved in 6 hours after surgery (VAS < 3). At 12 hours after operation, the VAS of resting and motion were 4.68 ± 2.27, 6.90 ± 2.43, respectively. While the grade of muscle strength was 4.48 ± 0.51 at 12 hours after operation. There is a high incidence of pulmonary edema in shoulder arthroscopy, and ultrasound is a convenient tool to evaluate this complication. Pain is relieved in 6 hours after surgery by nerve block. While muscle strength can also recover at 12 hours after surgery.

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Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy

Cited by 11 publications

References 6 publications

Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

Effects of irrigation fluid in shoulder arthroscopy

Pulmonary edema following shoulder arthroscopy under general anesthesia with nerve block

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