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Kateros K, Skotidis E, Bablekos GD, Vlachou M, Giatroudakis K, Theodorolea O, Galanakos SP. Pneumothorax After Shoulder Arthroscopy: A Rare Complication of Rotator Cuff Repair Surgery. Cureus 2023; 15:e36774. [PMID: 37123737 PMCID: PMC10145774 DOI: 10.7759/cureus.36774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2023] [Indexed: 03/30/2023] Open
Abstract
Shoulder arthroscopy is considered a very safe surgical procedure; however, there are possible complications that are prevalent or devastating. This article presents a 52-year-old woman scheduled for elective arthroscopic rotator cuff repair under general anesthesia in the lateral decubitus position. Postoperatively, the patient experienced dyspnea, chest pain, and oxygen desaturation, and a diagnosis of pneumothorax was made. A chest tube was inserted promptly and the patient was discharged in a good condition, experiencing an uneventful follow-up for the next four months. Knowledge of this uncommon complication may enable both surgeons and anesthesiologists to set up preventive and early therapeutic management.
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Vetrugno L, Divella M, Orso D, Deana C, Vaccher G, Drovandi P, Beltrame A, Causero A, Bove T. Tracheal lesion during shoulder surgery: a case report and systemic review of the literature. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE (ONLINE) 2021; 1:11. [PMID: 37386524 DOI: 10.1186/s44158-021-00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 07/01/2023]
Abstract
Pneumomediastinum (PNM) and pneumothorax (PNX) are documented complications of arthroscopic shoulder surgery (ATS). Plexus anesthetic block and tracheal lesions during endotracheal intubation are hypothesized to be the underlying risk factors; however, the actual evidence supporting this hypothesis is scarce.A case of bilateral laterocervical emphysema, subcutaneous edema, and signs of PNM after ATS performed under general anesthesia and supra-scapular nerve block is presented. An up-to-date systematic review of PNM/PNX during orthopedic surgery was performed, involving six databases: PubMed (1996-present), Embase (1974-present), Scopus (2004-present), SpringerLink (1950-present), Ovid Emcare (1995-present), and Google Scholar (2004-present).Twenty-five case studies met the eligibility criteria. In 24 cases, the patient underwent general anesthesia and orotracheal intubation; in 9 of these, a plexus anesthetic block was also performed. One case involved ATS under plexus anesthetic block only. In 10 cases, the diagnostic finding was PNM. In 5 cases, the diagnostic finding was associated with PNX. PNX was detected in 17 cases. In 2 cases, SE was found in the absence of any evidence of either PNM or PNX. A tracheal lesion was identified in 3 cases.Endotracheal intubation and loco-regional anesthesia are not the only predisposing risk factors at play in the pathogenesis of PNM/PNX. Rather, multi-factorial pathogenesis seems more probable, necessitating that specific attention is paid during ATS to the change in patient position on the operating bed, to any slipping of the endotracheal tube, to patient monitoring whilst under the drapes, and to the cuff pressure. PROSPERO registration number: CRD42021260370.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Michele Divella
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Daniele Orso
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Cristian Deana
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Giulia Vaccher
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Pietro Drovandi
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
| | - Alessandro Beltrame
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Araldo Causero
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Orthopedic and Trauma Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n. 50, 33100, Udine, Italy
- Anesthesia and Intensive Care Department, ASUFC University Hospital of Udine, P.le S. M. Misericordia n. 15, 33100, Udine, Italy
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Kim JB, Choi MK, Jeon YK, Lee JM. Chest wall swelling and pneumothorax after shoulder arthroscopy: Were the 2 events totally independent? Medicine (Baltimore) 2017; 96:e7020. [PMID: 28538422 PMCID: PMC5457902 DOI: 10.1097/md.0000000000007020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Arthroscopic shoulder surgery (ASS) is a low mortality and morbidity procedure, but anesthetic complications are reported. There have been no reports of combined chest wall swelling and pneumothorax after ASS. PATIENT CONCERNS The patient's right lung was severely collapsed and the mediastinum was deviated after ASS. DIAGNOSIS Pneumothorax on right chest. INTERVENTIONS A chest tube was inserted and oxygen therapy was performed. OUTCOMES The patient was discharged uneventfully. LESSONS Elective ASS has low mortality and morbidity rates, but we should be more concerned over the complications after ASS.
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Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy. J Shoulder Elbow Surg 2017; 26:745-751. [PMID: 28318850 DOI: 10.1016/j.jse.2017.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during shoulder arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for shoulder arthroscopy. METHODS A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation shoulder scores RESULTS: Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in shoulder girth (P < .05), and a significantly lower immediate postoperative visual analog scale pain score (P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant (P > .2). CONCLUSION A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for shoulder arthroscopy has potential clinical benefits to surgeons and patients.
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Saseendar S, Tan SHS, Vijayan S, Pawaskar A, Kumar VP. Extensive subcutaneous emphysema complicating a percutaneous Mumford procedure. Knee Surg Sports Traumatol Arthrosc 2016; 24:1907-10. [PMID: 25059337 DOI: 10.1007/s00167-014-3183-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
Abstract
Subcutaneous emphysema may be a part of a life-threatening pneumomediastinum or pneumothorax and usually does not occur alone. A case of a 75-year-old lady who underwent a percutaneous Mumford procedure for acromioclavicular osteoarthrosis has been reported. She developed extensive subcutaneous emphysema of the neck, chest, bilateral shoulders, and upper arms, in the absence of pneumomediastinum or pneumothorax, during the procedure. Isolated subcutaneous emphysema as a complication of a percutaneous Mumford procedure has not been reported so far in the English literature. The possible mechanism of this complication is discussed. Understanding the mechanism is essential in avoiding this preventable complication.
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Affiliation(s)
- Shanmugasundaram Saseendar
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Si Heng Sharon Tan
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Sandeep Vijayan
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Aditya Pawaskar
- Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Veerasingam Prem Kumar
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
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Leander-Olsson O, Borglund-Hemph A, Jakobsson JG. Pneumothorax following shoulder arthroscopy under combined regional and general anaesthesia-A case report. Int J Surg Case Rep 2016; 24:73-6. [PMID: 27218200 PMCID: PMC4885014 DOI: 10.1016/j.ijscr.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 12/27/2022] Open
Abstract
Needle punctures, upper extremity block, infiltration associated to surgery. Surgery related forces; diathermia in close proximity to the pleural space, any external force that may cause changes in the pleural pressures, e.g. shavers, profound pressure associated breast implant, reconstruction etc. Anaesthesia-associated factors; any “accidental” high peak bronchial pressures e.g. caused by bronch intubation or use of a tube-exchange catheter, especially with continuous oxygen flow, and possibly enforced lung recruitment in a at risk patient. Patient factors; smoking and lung disease, COPD/emphysema, lung cancer, history of pneumothorax, recent thoracic trauma. Lung auscultation is not sufficient for identification of pneumothorax.
Introduction Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. Presentation of case We describe a patient with mild obesity and recent shoulder trauma scheduled for elective arthroscopy under combined interscalene block and general anaesthesia in the beach chair position. The block was performed with ultrasound guidance in accordance with the departmental routines and before the induction of general anaesthesia. The patient experienced low saturation shortly after administration of general anaesthesia. A thoracic ultrasound was performed in order to rule out pneumothorax and recruitment manoeuvres was done based on the suspicion of atelectasis. Surgery was commenced under pressure controlled ventilation and saturation was kept around 90 at FiO2 1.0 after recruitment manoeuvres. An initial postoperative lung X-ray on the operating table showed subcutaneous emphysema but no pneumothorax. A postoperative CT-thorax, patient still intubated, showed an extensive pneumothorax that was treated with pulmonary drainage. Patient had subsequently an uncomplicated postoperative course. Discussion We can not state “whom to blame”, the interscalene block, intubation and pressures assisted ventilation, recruitment manoeuvres, or surgery? In this paper we discuss possible causes that should raise the suspicion around pneumothorax in patients exhibiting unexpected low saturation perioperatively. Conclusion Compromised oxygenation during surgery that not respond to recruitment should raise suspicion about pneumothorax.
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Affiliation(s)
- Oskar Leander-Olsson
- Department of Anaesthesia & Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - Anna Borglund-Hemph
- Department of Anaesthesia & Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds University Hospital, Stockholm, Sweden.
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Capito NM, Smith MJ, Stoker AM, Werner N, Cook JL. Hyperosmolar irrigation compared with a standard solution in a canine shoulder arthroscopy model. J Shoulder Elbow Surg 2015; 24:1243-8. [PMID: 25725966 DOI: 10.1016/j.jse.2014.12.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/09/2014] [Accepted: 12/23/2014] [Indexed: 02/01/2023]
Abstract
BACKGROUND A hyperosmolar irrigation solution may decrease fluid extravasation during arthroscopic procedures. Demonstrating the safety of a hyperosmolar irrigation solution with respect to chondrocyte viability and cartilage water content was deemed necessary before designing a clinical efficacy study. METHODS We designed a translational animal model study in which hyperosmolar arthroscopy irrigation fluid (1.8%, 600 mOsm/L) was compared with normal saline (0.9%, 300 mOsm/L). Purpose-bred research dogs (n = 5) underwent bilateral shoulder arthroscopy. Irrigation fluid was delivered to each shoulder joint (n = 10) at 40 mm Hg for 120 minutes using standard ingress and egress portals. The percentage change in shoulder girth was documented at the completion of 120 minutes. Articular cartilage sections from the glenoid and humeral head were harvested from both shoulders. Chondrocyte viability and tissue water content were evaluated. Differences between groups and compared with time 0 controls were determined, with significance set at P <.05. RESULTS The mean percentage change in shoulder girth was higher in the isotonic control group (13.3%) than in the hyperosmolar group (10.4%). Chondrocyte viability and tissue water content for glenoid and humeral head cartilage were well maintained in both treatment groups, and differences were not statistically significant. CONCLUSIONS The data from this study suggest that doubling the osmolarity of the standard irrigation solution used for arthroscopy was not associated with any detrimental effects on chondrocyte viability or tissue water content after 2 hours of arthroscopic irrigation. On the basis of potential benefits in conjunction with the safety demonstrated in these data, clinical evaluation of a hyperosmolar solution for irrigation during shoulder arthroscopy appears warranted.
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Affiliation(s)
- Nicholas M Capito
- Department of Orthopaedics, University of Missouri, Columbia, MO, USA.
| | - Matthew J Smith
- Department of Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Aaron M Stoker
- Department of Orthopaedics, University of Missouri, Columbia, MO, USA
| | - Nikki Werner
- Department of Orthopaedics, University of Missouri, Columbia, MO, USA
| | - James L Cook
- Department of Orthopaedics, University of Missouri, Columbia, MO, USA
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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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Martin CT, Gao Y, Pugely AJ, Wolf BR. 30-day morbidity and mortality after elective shoulder arthroscopy: a review of 9410 cases. J Shoulder Elbow Surg 2013; 22:1667-1675.e1. [PMID: 24060598 DOI: 10.1016/j.jse.2013.06.022] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have reported incidence of or risk factors for morbidity and mortality after elective shoulder arthroscopy. METHODS We used Current Procedural Terminology (CPT) billing codes to query the National Surgical Quality Improvement Program database and identified 9410 cases of elective shoulder arthroscopy. Univariate and multivariate analyses were used to identify risk factors for complication. RESULTS Among 9410 patients, 109 complications occurred in 93 (0.99%). Major morbidity was 0.54% (51 patients), which included 4 patients (0.04%) with a mortality, and minor morbidity was 0.44% (42 patients). The most common complication was a return to the operating room (29 cases, 0.31%). Superficial surgical site infections occurred in 15 cases (0.16%), deep infections in 1 (0.01%), deep venous thrombosis or thrombophlebitis in 8 (0.09%), peripheral nerve injury in 1 (0.01%), and pulmonary embolism in 6 (0.06%). The multivariate analysis showed smoking history (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.12-3.27), history of chronic obstructive pulmonary disease (OR, 3.25; 94% CI, 1.38-7.66), operative time of longer than 1.5 hours (OR, 2.1; 95% CI, 1.32-3.36), and American Society of Anesthesia class of 3 or 4 compared with 1 or 2 (OR, 1.82; 95% CI, 1.03-3.21) as risk factors for complication. CONCLUSIONS Morbidity and mortality are rare events after elective shoulder arthroscopy, and the procedure should generally be considered safe. Surgeons should offer smoking cessation to active users of tobacco and should be efficient with operative time whenever possible. LEVEL OF EVIDENCE Level II, prospective cohort design, treatment study.
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Affiliation(s)
- Christopher T Martin
- Department of Orthopaedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Kim HK, Ko ES, Kim JY, Park JM, Kim JY, Woo NS. Pneumomediastinum after arthroscopic shoulder surgery -A case report-. Korean J Anesthesiol 2013; 64:376-9. [PMID: 23646251 PMCID: PMC3640174 DOI: 10.4097/kjae.2013.64.4.376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/16/2012] [Accepted: 07/17/2012] [Indexed: 12/28/2022] Open
Abstract
An 86-year-old female with a history of right rotator cuff injury was admitted for arthroscopic shoulder surgery under general anesthesia. There were no remarkable immediate postoperative complications. However, while recovering in the general ward, she developed dyspnea with hypoxia. She was immediately treated with oxygen, and antibiotics after pneumomediastinum was confirmed on both chest x-ray and chest computed tomography. Subcutaneous emphysema on either face or neck followed by arthroscopic shoulder surgery was common, but pneumomediastinum with hypoxia is a rare but extremely dangerous complication. Thus we would like to report our case and its pathology, the diagnosis, the treatment and prevention, with literature review.
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Affiliation(s)
- Hae-Kyoung Kim
- Department of Anesthesiology and Pain Medicine, Konkuk University School of Medicine, Seoul, Korea
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Calvisi V, Lupparelli S, Rossetti S. Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block: a case report and review of the literature. Arch Orthop Trauma Surg 2009; 129:349-52. [PMID: 18283470 DOI: 10.1007/s00402-008-0593-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Indexed: 12/11/2022]
Abstract
A number of complications are associated with shoulder arthroscopic surgery. However rare, respiratory complications such as pneumomediastinum and related tension pneumothorax as well as spontaneous pneumothorax in patients undergoing shoulder arthroscopy by endotracheal intubation have been reported in the literature. Although the exact pathogenetic mechanisms remain undetermined, surgery-related factors as well as associated respiratory comorbidity have been hypothesized to intervene in the onset of respiratory complications. We report on one patient who developed subcutaneous and mediastinic emphysema after arthroscopic subacromial decompression performed by loco-regional anesthesia. Pathogenetic hypotheses including potential surgery- and anesthesia-related factors as well as associated respiratory comorbid illness are briefly discussed. Knowledge of potential pathogenetic variables may enable both surgeons and anesthesiologists to set up preventive and early treatment measures. Finally, patients' perception of arthroscopic surgery as a minimally invasive procedure might challenge the patient-surgeon relationship if respiratory complications occur that have not been included in the informed consent.
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Affiliation(s)
- Vittorio Calvisi
- Department of Orthopaedic Surgery, L'Aquila University, Coppito L'Aquila, Italy.
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Yang HS, Huh IY, Kim D, Son HW, Park ES, Park SE. Pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery: A case report. Korean J Anesthesiol 2009; 56:217-220. [PMID: 30625726 DOI: 10.4097/kjae.2009.56.2.217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Arthroscopic shoulder surgery has become a common and routine procedure because it provides several advantages for the diagnosis and therapy of shoulder injuries. However, shoulder arthroscopy is not a technique that's void of complications. We describe here a unique case of a patient who experienced pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery, and this surgery was done under general anesthesia.
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Affiliation(s)
- Hyun Suk Yang
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
| | - In Young Huh
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
| | - Daewoo Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
| | - Hee Won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
| | - Eun Sun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
| | - Soon Eun Park
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea.
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Martínez Gómiz J, López Mombiela F, Vaquero Martín J. Irrigation Systems in Shoulder Arthroscopy. Rev Esp Cir Ortop Traumatol (Engl Ed) 2008. [DOI: 10.1016/s1988-8856(08)70104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
PURPOSE The primary purpose of this study was to determine the amount of weight gain immediately after shoulder arthroscopy. In addition, patient and surgical factors correlated with weight gain were analyzed. We hypothesized that there would be a significant increase in weight immediately after shoulder arthroscopy and that the amount of weight gain would correlate with a number of surgical factors. TYPE OF STUDY Observational case series. METHODS Fifty-three patients were enrolled in the study. There were 34 male and 19 female patients, with a mean age of 47.1 +/- 13.8 years. All patients were weighed before and after surgery using the same weight scale by the same observer. Weight gain was calculated and adjusted to account for the weight of the dressing and sling. Weight gain then was correlated to various clinical and surgical variables. Pearson correlation coefficients, Student t tests, and stepwise regression were used to determine significant correlations between clinical and surgical variables and weight gain. RESULTS The mean amount of net weight gain was 8.7 +/- 3.9 lb (range, 0.8-18.8 lb), representing 4.6% +/- 2.1% of preoperative weight. The mean amount of weight gain attributable to arthroscopy fluid only was 4.2 +/- 3.8 lb (range, 0-14.5 lb), representing a gain of 2.2% +/- 2.0% of preoperative weight. The mean amount of intravenous fluid infused was 1,885 +/- 547 mL, and the mean amount of normal saline arthroscopy fluid used was 30 +/- 24 L. Surgical time, the amount of arthroscopy fluid, the size of the rotator cuff tear, the number of tendons involved, the presence of a subscapularis tear, the number of procedures performed, the concomitant performance of a subacromial decompression, the number of BioCorkscrew (Arthrex, Inc., Naples, FL) anchors used, and the total number of anchors used all correlated with increasing weight gain (all P < .05). A procedure of stepwise regression selection did not identify any quantitative parameters attributable to weight gain other than the earlier-described parameters. There were no significant intraoperative or postoperative complications attributable to the amount of weight gain. CONCLUSIONS Weight gain immediately after shoulder arthroscopy is a common finding. Although no complications were seen in this group of patients, both patients and surgeons should be aware of this concern after shoulder arthroscopy and the potential complications related to it.
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Affiliation(s)
- Ian K Y Lo
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA
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Abstract
We review the literature on complication of arthroscopic shoulder surgery and their management. Computer data based searches were used to identify articles regarding complications of shoulder arthroscopy, as well as hand searches of Arthroscopy and Journal of Shoulder and Elbow Surgery over the last decade. Arthroscopic shoulder surgery has become a popular therapeutic and diagnostic procedure during the past two decades. As with all interventions complications can occur which require recognition and management by the orthopedic surgeon. While the literature is helpful with identifying types of complications, establishing the rate of these complications remains elusive. These complications can be divided into general complications, complications generic to all shoulder procedures, and complications specific to the type of procedure performed. General complications such as infection and anesthesia problems continue to show low incidences. Shoulder arthroscopy presents increased risk of complications over knee arthroscopy in regard to vascular and neurologic injury, fluid extravasation, stiffness, iatrogenic tendon injury, and equipment failure. New techniques of increased complexity for subacromial surgery, rotator cuff repair, and arthroscopic instability present new problems related to implant failure, nerve injury, iatrogenic fracture, and capsular necrosis. While the rate of complications especially with newer procedures remain elusive, most studies suggest that the rate is low, 5.8-9.5% in all recent review studies published. Underreporting complications makes assessment of incidence rates of complication difficult. Proper patient selection, attention to operative detail, and careful post-operative monitoring can minimize the morbidity associated with these complications.
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Affiliation(s)
- Stephen C Weber
- Sacramento Knee and Sports Medicine, Sacramento, California, USA.
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Abstract
Spontaneous subcutaneous emphysema is a rare and usually benign entity that may occasionally be symptomatic. We report a case of a patient with advanced cancer who developed extensive but asymptomatic subcutaneous emphysema shortly before death. Perforation of the lower gastrointestinal tract, perhaps as a result of straining due to severe unrelieved constipation or due to fistula formation, is suspected to have been the mechanism. The causes, treatment, and implications for management of this condition are discussed.
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Affiliation(s)
- S Chu
- Department of Medical Oncology and Palliative Care, Westmead Hospital, New South Wales, Australia
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Affiliation(s)
- S R Craig
- Department of Thoracic Surgery, City Hospital, Edinburgh, U.K
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