Severe refractory hypertension during shoulder arthroscopy

Abrons, Ron O.; Ellis, S.

doi:10.4103/1658-354x.168834

Cited by 6 publications

(4 citation statements)

References 2 publications

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“…There have also been several case reports in which patients were at risk due to severe refractory hypertension or arrhythmia during shoulder arthroscopic surgery with irrigation containing epinephrine. [5,6] However, in this study, the difference in hypertension events between the 2 groups was not statistically significant, and there were no patients with severe hemodynamic consequences. It can be considered that epinephrine added irrigation in spine endoscopic surgery may not pose a great risk.…”

Section: Discussioncontrasting

confidence: 54%

“…[ 1 , 4 ] However, there are some case reports of severe refractory hypertension and lethal arrhythmia when using epinephrine mixed saline irrigation fluid in shoulder arthroscopic surgery. [ 5 , 6 ] In our institute, while performing biportal endoscopic spine surgery (BESS), saline irrigation pressure makes the working space similar to a joint arthroscopic surgery, and 1 mg of epinephrine is added to 3 L of normal saline irrigation fluid, as in knee and shoulder surgery. [ 4 ] We also used a saline infusion pump with a pressure of 50 mm Hg, which is higher than the average venous pressure of 40 mm Hg to prevent venous bleeding for visualization.…”

Section: Introductionmentioning

confidence: 99%

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Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Ko¹,

Cho²,

Jang³

et al. 2022

Medicine

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During endoscopic orthopedic surgery, epinephrine mixed with irrigation saline is frequently used to improve visualization. By monitoring hemodynamic parameters throughout the procedure, we intended to discover the hemodynamic effect of epinephrine between the normal saline irrigation fluid without epinephrine group (NS) and normal saline irrigation fluid with epinephrine group (EPI).Patients who underwent 1-level lumbar decompression or discectomy surgery without fusion between August 2019 and July 2020 were reviewed retrospectively. The hemodynamic parameters were compared between the NS group and EPI group. As a second endpoint, the incidence of hypotension and hypertension events, expected blood loss, postoperative nausea and vomiting and postoperative epidural hematoma were compared between the 2 groups.The 2 groups were homogeneous in terms of age, sex, weight, height, body mass index (BMI), ASA physical status (ASA PS), and diagnosis. The incidence of hypotension events (67.2 % in the NS group, 45.7 % in the EPI group, P =.015) and severe hypotension events (51.7 % in the NS group, 28.6 % in the EPI group, P = .015) were less frequent in the EPI group. Only epinephrine had a significant protective effect through a multivariable analysis (P = .027, OR = 2.361) and in severe hypotension events, only epinephrine had a significant protective effect through a multivariable analysis (P = .011, OR = 2.818), and EBL was the risk factor through a multivariable analysis (P = .016, OR = 1.002)We believe that the addition of epinephrine to irrigation saline has hemodynamic protective effects in patients who underwent endoscopic lumbar surgery.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Ko¹,

Cho²,

Jang³

et al. 2022

Medicine

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“…However, risks do exist. Numerous complications have been described resulting from the systemic absorption of adrenaline-containing irrigation solution during arthroscopy, including posterior reversible encephalopathy syndrome, potentially fatal arrhythmias, severe refractory hypertension and pulmonary oedema [5][6][7][8]. The only case pertaining to TCM during arthroscopy was described by Gicquel-Schlemmer et al, and the outcome was fatal [9].…”

Section: Discussionmentioning

confidence: 99%

Reverse takotsubo cardiomyopathy induced by adrenaline‐containing irrigation solution during shoulder arthroscopy*

Azem

Kaplan

Zribi

et al. 2023

Anaesthesia Reports

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SummaryTakotsubo cardiomyopathy is characterised by reversible systolic dysfunction resulting from catecholamine‐induced vasospasm, mainly triggered by intense emotional or physical stress. Adding adrenaline to arthroscopic irrigation solution enhances visibility by minimising bleeding. However, there is a risk of complications due to systemic absorption. Several severe cardiac consequences have been described. Here, we present a case of a patient who underwent elective shoulder arthroscopy involving an adrenaline‐containing irrigation solution. Forty‐five minutes after surgery began, he developed ventricular arrhythmias with hemodynamic instability, necessitating vasopressor support. Bedside transthoracic echocardiography revealed severe left ventricular dysfunction with basal ballooning, and emergent coronary angiography revealed normal coronary arteries. These findings correspond to a reverse variant of takotsubo cardiomyopathy. The patient was transferred to the intensive cardiac care unit sedated, ventilated and hemodynamically supported. Three days following the procedure, he was successfully weaned from vasopressors and mechanical ventilation. Transthoracic echocardiography 3 months after surgery demonstrated complete left ventricular function recovery. Although complications due to adrenaline‐containing irrigation solutions are rare, a growing body of case reports should prompt consideration of the safety of this practice.

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“…5 Vascular circulation has been shown 6 , although serious adverse events are rare in the literature. [7][8][9][10][11][12][13][14] Two doses of adrenaline (0.33 mg/l and 1 mg/l) have been evaluated in the literature against placebo but have never been compared with each other. 5,6,[15][16][17]…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effects of two concentrations of adrenaline (0.33 mg/l versus 1 mg/l) in the irrigation serum for arthroscopic shoulder surgery: protocol of a randomized controlled trial

Harly,

Billaud,

Demezon

et al. 2024

Int J Clin Trials

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Background: Controlling bleeding during arthroscopic shoulder surgery helps improve the clarity of the arthroscopic visual field. Adrenaline is considered an effective and safe method to reduce bleeding. Two doses of adrenaline (0.33 mg/l and 1 mg/l) have been evaluated in the literature, but never against each other. Methods: This prospective, double-blind, randomized controlled trial will study the clarity of the visual field using a numerical scale (NS) during rotator cuff surgery on 180 patients across 5 centres. The secondary objectives include: the duration of the operation, volume of saline used, increase in baseline pressure, number of arthropump hyperpressures, mean systolic blood pressure and heart rate, as well as sudden variability. Results: Among the 154 patients in the Clinical Trial Group, 70/154 (45%) continued to have proteinuria, while 84/154 (55%) had no proteinuria (remission) compared to 41 (28%) in remission and 104 (72%) with continued proteinuria in the Usual Care group (p<0.001). Conclusions: This study aims to determine which of the two dosages previously studied in the literature (0.33 mg/l versus 1 mg/l) provides better clarity. Trial Registration Number: 2021-A02773-38.

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Severe refractory hypertension during shoulder arthroscopy

Cited by 6 publications

References 2 publications

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Hemodynamic protective effects of epinephrine containing saline irrigation in biportal endoscopic lumbar surgery

Reverse takotsubo cardiomyopathy induced by adrenaline‐containing irrigation solution during shoulder arthroscopy*

Comparison of the effects of two concentrations of adrenaline (0.33 mg/l versus 1 mg/l) in the irrigation serum for arthroscopic shoulder surgery: protocol of a randomized controlled trial

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