A Study of Perioperative Complications and Its Correlation With Amount of Irrigation Fluid Used in Patients Undergoing Shoulder Arthroscopy

Abstract

Introduction: Arthroscopic shoulder surgery is a minimally invasive technique performed for diagnostic and therapeutic purposes. Advances in arthroscopy permit many procedures to be performed primarily or adjunctively through the arthroscope. Commonest indications of shoulder arthroscopy is usually performed for Shoulder instability, Bankart’s lesion, Supraspinatus tear, Meniscus tear, Impingement syndrome, Rotator cuff tears, Calcific tendonitis tendinitis and Frozen shoulder. Recent evidences, however, have increasingly focused on complications related to use of irrigation fluid, patient positioning and anaesthesia during shoulder arthroscopy. The risk of complications can be reduced with an experienced surgeon, lesser surgical duration, use of controlled pump pressures and controlled flow rate of irrigation fluids.
 Material and Methods: The present prospective study involves an analysis of perioperative monitoring of effects of amount of irrigation fluid in patient undergoing shoulder arthroscopy. With objective to see the Effect of irrigation fluid absorption on measurable parameters and to identify whether these parameters help in predicting airway/ respiratory compromise or cardiac complications.All the patients of any ASA Grade, sex and above 18 years who were posted for shoulder arthroscopy were included in the study. 72 patients who were undergoing shoulder arthroscopy were invited to participate in this observational study. Complete histories were obtained and thorough clinical examination was carried out. Brachial plexus block with general anaesthesia were given to all the patients.
 Results: Out of 72 patients 54(75%) were males and 18(25%) were females.30 litres or less irrigation fluid is used in 47(65.3%) patients, between 30-40 litres is used in 24(33%) patients and 40 litres or more irrigation fluid is used in 1( 1.4%) patient. Baseline pulse rate was 79.85±8.11 per minutes, which started decreasing from T4 (1.4%) to throughout the procedure and this fall was found to be statistically significant. The maximum fall in pulse rate at 160 minutes (19.8%). Pulse rate increases from 200 minutes till the end of the surgery. Baseline mean BP was 101.63±7.90 mm Hg, which started decreasing from T1 (16.1%) to throughout the procedure and this fall was found to be statistically significant. the leak test and delayed extubation in patients undergoing shoulder arthroscopy. Towards the end of procedure and prior to extubation 4(5.6%) patients showed negative leak test and hence, had delayed extubation, and 68(94.4%) patients showed positive leak test and normal extubation and statistically significant. Mid arm circumference was increased by 14.2%, neck circumference was increased by 10.4%, haemoglobin (Hb) was decreased by 6.6%, serum sodium (Na) was decreased by 4.6% and serum potassium (K) was decreased by 16.2%. Post-operative changes in all these parameters was found to be statistically significant.
 Conclusion: Extravasation of irrigation fluid used during shoulder arthroscopy can be disastrous leading to various complications like airway oedema, tracheal compression extensive subcutaneous emphysema, pneumomediastinum, tension pneumothorax and air embolism. The risk of regional and systemic absorption of irrigation fluid is directly proportional to amount of irrigation fluid used and duration of surgery. The measurement of neck circumference can be a clinical predictor for airway oedema following shoulder arthroscopy. We recommend to with hold extubation when the neck circumference increases by more than 6 cm