The Effect of the Shoulder Arthroscopic Surgery on Respiratory Mechanics

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.

Study Overview

• Status: Completed
• Conditions: 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.

• Study Type: Observational
• Enrollment (Actual): 60

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 69 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

patients undergoing arthroscopic shoulder rotator cuff repair surgery

Description

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

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Static compliance	Static compliance (mL/cmH2O) before and after the arthroscopic surgery ,Static compliance = tidal volume delivered / (plateau pressure - PEEP)	before and after arthroscopic surgery, an expected average of 80 minutes
dynamic compliance	dynamic compliance (mL/cm H2O) before and after the arthroscpic surgery ,dynamic compliance = tidal volume delivered / (peak pressure - PEEP)	before and after arthroscopic surgery, an expected average of 80 minutes

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
inspiratory tidal volume	inspiratory tidal volume (ml) before and after the arthroscpic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
expiratory tidal volume	expiratory tidal volume (ml) before and after the arthroscpic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
peak inspiratory pressure	peak inspiratory pressure (cm H2O) before and after the arthroscpic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
physiologic dead space	physiologic dead space (VD/VT) before and after arthroscopic surgery ,VD/VT = (PaCO2 - PeCO2)/PaCO2, PeCO2 = mixed expired CO2	before and after arthroscopic surgery, an expected average of 80 minutes
plateau airway pressure	plateau airway pressure (cmH2O) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
Mean airway pressure	Mean airway pressure (cm H2O) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
positive end expiratory pressure	positive end expiratory pressure (cmH2O) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
inspiratory resistance	inspiratory resistance (cmH2O/L sec) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
expiratory resistance	expiratory resistance (cmH2O/ L sec)before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
peak inspiratory flow	peak inspiratory flow (L/min) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
peak expiratory flow	peak expiratory flow (L/min) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
Work of breathing	Work of breathing (J/L) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
end tidal CO2	end tidal CO2 (mmHg) before and after arthroscopic surgery	before and after arthroscopic surgery, an expected average of 80 minutes
arterial oxygen tension	arterial oxygen tension (mmHg) measured by arterial blood gas analysis	before and after arthroscopic surgery, an expected average of 80 minutes
arterial CO2 tension	arterial CO2 tension (mmHg)as measured by arterial blood gas analysis	before and after arthroscopic surgery, an expected average of 80 minutes
forced vital capacity (FVC)	forced vital capacity measured by portable spirometry	before and after general anesthesia, an expected average of 120 minutes
forced expiratory volume for 1 second (FEV1)	forced expiratory volume for 1 second (FEV1)measure by portable spirometry	before and after general anesthesia, an expected average of 120 minutes

Collaborators and Investigators

• Sponsor: Samsung Medical Center

Study record dates

Study Major Dates

• Study Start: June 1, 2011
• Primary Completion (ACTUAL): April 1, 2012
• Study Completion (ACTUAL): April 1, 2012

Study Registration Dates

• First Submitted: July 5, 2011
• First Submitted That Met QC Criteria: July 31, 2011
• First Posted (ESTIMATE): August 2, 2011

Study Record Updates

• Last Update Posted (ESTIMATE): April 30, 2013
• Last Update Submitted That Met QC Criteria: April 28, 2013
• Last Verified: April 1, 2013

More Information

Terms related to this study

• Keywords: airway obstruction; shoulder arthroscopic surgery; respiratory discomfort; restrictive pathology; diaphragm palsy
• Other Study ID Numbers: 2011-06-031