Shoulder Arthroscopic Surgery
Conditions
Keywords
shoulder arthroscopic surgery, respiratory discomfort, airway obstruction, restrictive pathology, diaphragm palsy
Brief summary
During shoulder arthroscopic surgery, extravasation of irrigation fluid can occur around the shoulder and trachea, compressing the upper airway. Although the extravasation is generally reabsorbed asymptomatically within 12 hours, there are cases that lead to reintubation or life-threatening complications. Furthermore, the soft tissue edema around the shoulder may extend to the thoracic cage, compress the chest and induce the respiratory distress immediately after surgery. The investigators attempt to determine the effect of shoulder arthroscopic surgery on respiratory mechanics. Changes in respiratory mechanics and arterial blood gases were measured and compared before and after the shoulder arthroscopic surgery.
Detailed description
Currently, most shoulder surgeries are performed with arthroscopy. The advantages of shoulder arthroscopic surgery are decreased blood loss due to minimal incision for scope, a reduced operation time, minimization of surgical stress, and rapid recovery time after surgery. During shoulder arthroscopic surgery, extravasation of irrigation fluid can occur around the shoulder and trachea, compressing the upper airway. Although the extravasation is generally reabsorbed asymptomatically within 12 hours, there are cases that lead to reintubation or life-threatening complications. Furthermore, the soft tissue edema around the shoulder may extend to the thoracic cage, compress the chest and induce the respiratory distress immediately after surgery. From these facts, the mechanism of respiratory discomfort after shoulder arthroscopic surgery may be because the upper airway obstruction or restrictive pathology due to direct compression of thoracic cage by the soft tissue edema. There have been no studies on the respiratory effect of shoulder arthroscopic surgery. We have observed frequent and severe respiratory discomfort after the shoulder arthroscopic surgery. Therefore, in this study we attempt to determine the effect of shoulder arthroscopic surgery on respiratory mechanics. Changes in respiratory mechanics and arterial blood gases were measured and compared before and after the shoulder arthroscopic surgery.
Interventions
None listed
Sponsors
Samsung Medical Center
Study design
Observational model
CASE_ONLY
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
20 Years to 69 Years
Healthy volunteers
No
Inclusion criteria
* Patients undergoing arthroscopic shoulder rotator cuff repair surgery * American society of anesthesiologist (ASA) class I or II * Patients under 70 yrs.
Exclusion criteria
* Patients older than 70 yrs, * Patients with anatomical derangement of upper airway, * Patients with pulmonary or cardiac disease, * Patients with a history of laryngeal or tracheal surgery or hemodynamic instability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Static compliance | before and after arthroscopic surgery, an expected average of 80 minutes | Static compliance (mL/cmH2O) before and after the arthroscopic surgery ,Static compliance = tidal volume delivered / (plateau pressure - PEEP) |
| dynamic compliance | before and after arthroscopic surgery, an expected average of 80 minutes | dynamic compliance (mL/cm H2O) before and after the arthroscpic surgery ,dynamic compliance = tidal volume delivered / (peak pressure - PEEP) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| peak inspiratory pressure | before and after arthroscopic surgery, an expected average of 80 minutes | peak inspiratory pressure (cm H2O) before and after the arthroscpic surgery |
| physiologic dead space | before and after arthroscopic surgery, an expected average of 80 minutes | physiologic dead space (VD/VT) before and after arthroscopic surgery ,VD/VT = (PaCO2 - PeCO2)/PaCO2, PeCO2 = mixed expired CO2 |
| plateau airway pressure | before and after arthroscopic surgery, an expected average of 80 minutes | plateau airway pressure (cmH2O) before and after arthroscopic surgery |
| Mean airway pressure | before and after arthroscopic surgery, an expected average of 80 minutes | Mean airway pressure (cm H2O) before and after arthroscopic surgery |
| positive end expiratory pressure | before and after arthroscopic surgery, an expected average of 80 minutes | positive end expiratory pressure (cmH2O) before and after arthroscopic surgery |
| inspiratory resistance | before and after arthroscopic surgery, an expected average of 80 minutes | inspiratory resistance (cmH2O/L sec) before and after arthroscopic surgery |
| expiratory resistance | before and after arthroscopic surgery, an expected average of 80 minutes | expiratory resistance (cmH2O/ L sec)before and after arthroscopic surgery |
| inspiratory tidal volume | before and after arthroscopic surgery, an expected average of 80 minutes | inspiratory tidal volume (ml) before and after the arthroscpic surgery |
| peak expiratory flow | before and after arthroscopic surgery, an expected average of 80 minutes | peak expiratory flow (L/min) before and after arthroscopic surgery |
| Work of breathing | before and after arthroscopic surgery, an expected average of 80 minutes | Work of breathing (J/L) before and after arthroscopic surgery |
| end tidal CO2 | before and after arthroscopic surgery, an expected average of 80 minutes | end tidal CO2 (mmHg) before and after arthroscopic surgery |
| arterial oxygen tension | before and after arthroscopic surgery, an expected average of 80 minutes | arterial oxygen tension (mmHg) measured by arterial blood gas analysis |
| arterial CO2 tension | before and after arthroscopic surgery, an expected average of 80 minutes | arterial CO2 tension (mmHg)as measured by arterial blood gas analysis |
| forced vital capacity (FVC) | before and after general anesthesia, an expected average of 120 minutes | forced vital capacity measured by portable spirometry |
| forced expiratory volume for 1 second (FEV1) | before and after general anesthesia, an expected average of 120 minutes | forced expiratory volume for 1 second (FEV1)measure by portable spirometry |
| peak inspiratory flow | before and after arthroscopic surgery, an expected average of 80 minutes | peak inspiratory flow (L/min) before and after arthroscopic surgery |
| expiratory tidal volume | before and after arthroscopic surgery, an expected average of 80 minutes | expiratory tidal volume (ml) before and after the arthroscpic surgery |
Countries
South Korea
Outcome results
None listed