The Predictor of Respiratory Discomfort After the Shoulder Arthroscopic Surgery

The Predictor of Respiratory Discomfort After the Shoulder Arthroscopic Surgery as Measured by Upper Airway Ultrasonography

The investigators applied upper airway ultrasonographic examination focusing the measurement of upper airway diameters in patients undergoing shoulder arthroscopic surgery to evaluate the change of upper airway anatomy before and after the surgery. The investigators also tried to find any findings of ultrasonographic examination that could reliably predict the dyspnea or airway compression after extubation. The investigators tried to compare the ultrasonographic findings with those of chest radiograph to validate the measurements of the ultrasonographic examination. A cuff leak test was preformed to evaluate its ability to predict the upper airway obstruction in shoulder arthroscopic surgery.

Study Overview

• Status: Completed
• Conditions: Shoulder Arthroscopic Surgery
• Intervention / Treatment: Other: upper airway ultrasonographic examination

Detailed Description

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.

An endotracheal tube is the most reliable method of securing the airway from airway obstruction during a shoulder arthroscopy surgery. However, since the airway may become obstructed after extubation, airway patency should be verified before extubation. Direct visualization of the larynx or trachea using laryngoscopy or bronchoscopy is difficult due to the presence of the tracheal tube. A cuff leak around the tracheal tube in a cuff-deflated condition is suggested to be a predictor of successful extubation. However, its reliability has been questioned in adult patients. A cuff leak could be affected by paratracheal pressure, which is thought to be elevated during shoulder arthroscopy. In a recent study, it was shown that laryngeal ultrasound can be a reliable, non-invasive method for the evaluation of laryngeal morphology or predicting post-extubation stridor.

The investigators applied upper airway ultrasonographic examination focusing the measurement of upper airway diameters in patients undergoing shoulder arthroscopic surgery to evaluate the change of upper airway anatomy before and after the surgery. The investigators also tried to find any findings of ultrasonographic examination that could reliably predict the dyspnea or airway compression after extubation. The investigators tried to compare the ultrasonographic findings with those of chest radiograph to validate the measurements of the ultrasonographic examination. A cuff leak test was preformed to evaluate its ability to predict the upper airway obstruction in shoulder arthroscopic surgery.

• Study Type: Observational
• Enrollment (Actual): 100

Contacts and Locations

Study Locations

• Korea, Republic of
  • Seoul, Korea, Republic of, 135-710
    • Samsung Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

patients undergoing elective shoulder arthroscopic surgery (rotator cuff repair)

Description

Inclusion Criteria:

• patients undergoing elective shoulder arthroscopic surgery (rotator cuff repair)

Exclusion Criteria:

• patients with airway anomaly
• patients with anticipated difficult airway
• patients with hemodynamic unstability
• patients with severe cardiopulmonary disease

Study Plan

How is the study designed?

Design Details

• Observational Models: Case-Only
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
shoulder arthroscopic surgery group; the patients who undergo the elective shoulder arthroscopic surgery of rotator cuff repair	Other: upper airway ultrasonographic examination; upper airway ultrasonographic examination and cuff leak test; Other Names: upper airway ultrasonographic examination ,; cuff leak test

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Airway transverse diameter	airway transverses diameter measured on the upper airway ultrasonographic image: measure at three level (vocal cord, subglottis, trachea)	10 min before anesthesia induction
Airway transverse diameter	airway transverses diameter measured on the upper airway ultrasonographic image: measure at three level (vocal cord, subglottis, trachea)	20 min after end of surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
depth of skin to airway anterior border	depth of skin to airway anterior border measured at three levels: vocal cord, subglottis, trachea level	10 min before anesthesia induction and 20 min after the surgery
depth of skin to pleura	bilateral depth of skin to pleura at first and third intercostal space on the midclavicualr line measuread on the ultrasonographic image	10 min before anesthesia induction and 20 min after the end of surgery
endotracheal tube balloon cuff pressure	endotracheal tube balloon cuff pressure	10 min after anesthesia induction and 60 min after surgery start
percent cuff leak	The difference in the actual exhaled volume between the averages of pre- and post-cuff deflation was calculated. This number was divided by the tidal volume before cuff deflation and multiplied by 100. The resulting number was recorded as the percent cuff leak.	10 min after anesthesia induction and 60 min after surgery start

Collaborators and Investigators

• Sponsor: Samsung Medical Center
• Investigators: Principal Investigator: Soo Joo Choi, M.D.,Ph.D., Samsung Medical Center

Study record dates

Study Major Dates

• Study Start: July 1, 2011
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): December 1, 2012

Study Registration Dates

• First Submitted: July 21, 2011
• First Submitted That Met QC Criteria: July 22, 2011
• First Posted (Estimate): July 25, 2011

Study Record Updates

• Last Update Posted (Estimate): December 25, 2013
• Last Update Submitted That Met QC Criteria: December 24, 2013
• Last Verified: December 1, 2013

More Information

Terms related to this study

• Keywords: dyspnea; shoulder arthroscopic surgery; airway diameter
• Other Study ID Numbers: 2011-06-028