Pulmonary edema following shoulder arthroscopy under general anesthesia with nerve block

Abstract

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.

Predictive model of hypoxemia after shoulder arthroscopy: A retrospective observational study

“…NB from ultrasound is an important diagnostic indicator of pulmonary edema, which were examined by Naviu color ultrasonic diagnostic system with low-frequency linear array probe (frequency 3.5–5.5 MHz), and 28 intercostal space scanning methods were used to measure NB of bilateral parasternal line, central clavicular line, anterior axillary line, central axillary line and posterior axillary line according to Picano Eugenio. [ 6 , 7 ] The secondary outcomes included the following information of the patient: sex, age, BMI, American Society of Anesthesiologists grade, hypertension, preoperative and postoperative hemoglobin concentration, type of surgery, duration of surgery, irrigation amount, volume of fluid in and out at intraoperative, blood loss, urine volume, dosage of opioids and muscle relaxants and the incidence of postoperative hypoxemia. Postoperative hypoxemia was defined as the lowest PaO 2 /FiO 2 in arterial blood gas ≤300 after oxygen inhalation through the nasal.…”

“…[ 6 ] The number of B-lines (NB) from ultrasound also plays an important role in evaluating the severity of pulmonary edema. [ 7 ]…”

“…[6] The number of B-lines (NB) from ultrasound also plays an important role in evaluating the severity of pulmonary edema. [7] For a better surgical view, shoulder arthroscopic surgery requires a lot of irrigation in some patients (>20 L). Unexplained hypoxemia can be found in patients, however, it is worth noting that those hypoxemia after shoulder arthroscopy can be life-threatening [8,9] Early prevention of hypoxemia after shoulder arthroscopy is a highly concerning issue for anesthesiologists.…”

The Safety Assessment of Irrigation Fluid Management for Shoulder Arthroscopy and Its Effect on Postoperative Efficacy

“…Zhang et al . found a 12.9% incidence of moderate‐to‐severe pulmonary edema through 93 patients who had arthroscopic surgery 11 . Sari et al .…”

“…2,7 Zhang et al found a 12.9% incidence of moderate-to-severe pulmonary edema through 93 patients who had arthroscopic surgery. 11 Sari et al found the incidence of hypothermia after postoperative 2 h was 100% and the hypothermia could lead to increased risk of cardiovascular disease. 12 Therefore, the occurrence of severe post-arthroscopic complications requires consideration on the impact on other organ systems and more effective evaluation factors.…”