Fluid Extravasation in Shoulder Arthroscopic Surgery: A Systematic Review

Muzammil Memon, Jeffrey Kay, Arian Gholami, Nicole Simunovic, Olufemi R Ayeni, Muzammil Memon, Jeffrey Kay, Arian Gholami, Nicole Simunovic, Olufemi R Ayeni

Abstract

Background: Arthroscopic surgery of the shoulder joint has become increasingly more common given its advantages over open surgery; however, one rare but potentially life-threatening complication is fluid extravasation into the surrounding tissues, causing edema, respiratory compromise, abnormal results on laboratory blood tests, and possibly death. Currently, no systematic review exists that summarizes the existing clinical research on this topic.

Purpose: To perform a systematic review on fluid extravasation as a complication of shoulder arthroscopic surgery, specifically assessing clinical presentation, risk factors, management, and outcomes.

Study design: Systematic review; Level of evidence, 4.

Methods: Two reviewers independently searched 3 databases (PubMed, Ovid [MEDLINE], and Embase) from database inception until July 1, 2017. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist guided the reporting and data abstraction. The methodological quality of these studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) checklist. The results are presented in a narrative summary fashion using descriptive statistics including ranges and agreement statistics.

Results: A total of 26 studies (20 case reports, 4 case series, and 2 prospective comparative studies) encompassing 205 patients (mean age, 50.8 years [range, 15-83 years]) were included. The most common signs of fluid extravasation included chest wall swelling (n = 86) and neck swelling (n = 116). In 32 patients, observation alone was sufficient. Other patients required airway intubation (n = 16), diuretics (n = 7), steroids (n = 1), and percutaneous drainage of fluid (n = 1). Clinical edema resolved after 2 to 48 hours, and patients were discharged 1 to 20 days postoperatively. Serious complications included transfer to the intensive care unit (n = 14), anterior interosseous nerve palsy (n = 4), rhabdomyolysis (n = 1), and death (n = 1).

Conclusion: Fluid extravasation has the potential to be a life-threatening complication of shoulder arthroscopic surgery; however, it is most commonly managed nonoperatively, and symptoms typically resolve with no evidence of long-term complications. Intraoperative surgical decisions, such as minimizing the surgical time and volume of irrigation fluid used, may limit fluid extravasation, while careful intraoperative monitoring may facilitate prompt diagnosis and management to optimize patient outcomes.

Keywords: anesthesia/pain management; cardiovascular physiology; epidemiology; injury prevention; muscle injuries; shoulder.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: O.R.A. is a consultant for ConMed, Smith & Nephew, and DJO.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram demonstrating the systematic review of the literature on fluid extravasation in shoulder arthroscopic surgery.

References

    1. Antonucci S, Orlandi P, Mattei PA, Amato F. Airway obstruction during arthroscopic shoulder surgery: anesthesia for the patient or for the surgeon? Minerva Anestesiol. 2006;72(12):995–1000.
    1. Berjano P, Gonzalez BG, Olmedo JF, Perez-Espana LA, Munilla MG. Complications in arthroscopic shoulder surgery. Arthroscopy. 1998;14(8):785–788.
    1. Blumenthal S, Nadig M, Gerber C, Borgeat A. Severe airway obstruction during arthroscopic shoulder surgery. Anesthesiology. 2003;99(6):1455–1456.
    1. Borgeat A, Bird P, Ekatodramis G, Dumont C. Tracheal compression caused by periarticular fluid accumulation: a rare complication of shoulder surgery. J Shoulder Elbow Surg. 2000;9(5):443–445.
    1. Brown AR, Weiss R, Greenberg C, Flatow EL, Bigliani LU. Interscalene block for shoulder arthroscopy: comparison with general anesthesia. Arthroscopy. 1993;9(3):295–300.
    1. Carr AJ, Price AJ, Glyn-Jones S, Rees JL. Advances in arthroscopy: indications and therapeutic applications. Nat Rev Rheumatol. 2015;11(2):77–85.
    1. Carr CF, Murphy JM. Deltoid and supraspinatus muscle pressures following various arthroscopic shoulder procedures. Arthroscopy. 1995;11(4):401–403.
    1. Chellam S, Chiplonkar S, Pathak K. Change in neck circumference after shoulder arthroscopy: an observational study. Indian J Anaesth. 2015;59(6):365–368.
    1. Chiplonkar S, Pathak K, Chellam S. Change in neck circumference after shoulder arthroscopy: an observational study. Indian J Anaesth. 2015;59(6):365.
    1. Conn RA, Cofield RH, Byer DE, Linstromberg JW. Interscalene block anesthesia for shoulder surgery. Clin Orthop Relat Res. 1987;(216):94–98.
    1. Edwards DS, Davis I, Jones NA, Simon DW. Rapid tracheal deviation and airway compromise due to fluid extravasation during shoulder arthroscopy. J Shoulder Elbow Surg. 2014;23(7):e163–e165.
    1. Ercin E, Bilgili MG, Ones HN, Kural C. Postoperative pectoral swelling after shoulder arthroscopy. Joints. 2016;3(3):158–160.
    1. Errando CL. Ultrasound observation of tissue fluid infiltration causing stridor in a woman undergoing shoulder arthroscopy. Rev Esp Anestesiol Reanim. 2011;58(9):582–584.
    1. Gogia A, Bajaj J, Sahni A, Saigal D. Negative-pressure pulmonary oedema in a patient undergoing shoulder arthroscopy. Indian J Anaesth. 2012;56(1):62.
    1. Gupta S, Manjuladevi M, Vasudeva Upadhyaya KS, Kutappa AM, Amaravathi R, Arpana J. Effects of irrigation fluid in shoulder arthroscopy. Indian J Anaesth. 2016;60(3):194–198.
    1. Gwak MS, Kim WH, Choi SJ, et al. Arthroscopic shoulder surgery under general anesthesia with brachial plexus block. Anaesthesist. 2013;62(2):113–120.
    1. Hynson JM, Tung A, Guevara JE, Katz JA, Glick JM, Shapiro WA. Complete airway obstruction during arthroscopic shoulder surgery. Anesth Analg. 1993;76(4):875–878.
    1. Ichai C, Ciais JF, Roussel LJ, et al. Intravascular absorption of glycine irrigating solution during shoulder arthroscopy: a case report and follow-up study. Anesthesiology. 1996;85(6):1481–1485.
    1. Jensen KH, Werther K, Stryger V, Schultz K, Falkenberg B. Arthroscopic shoulder surgery with epinephrine saline irrigation. Arthroscopy. 2001;17(6):578–581.
    1. Jirativanont T, Tritrakarn TD. Upper airway obstruction following arthroscopic rotator cuff repair due to excess irrigation fluid. Anaesth Intensive Care. 2010;38(5):957–958.
    1. Kay J, De Sa D, Memon M, Simunovic N, Paul J, Ayeni OR. Examining the role of perioperative nerve blocks in hip arthroscopy: a systematic review. Arthroscopy. 2016;32(4):704–715.e1.
    1. Khan F, Padmanabha S, Shantaram M, Aravind M. Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy. J Anaesthesiol Clin Pharmacol. 2013;29(4):578–579.
    1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–174.
    1. Liguori GA, Kahn RL, Gordon J, Gordon MA, Urban MK. The use of metoprolol and glycopyrrolate to prevent hypotensive/bradycardic events during shoulder arthroscopy in the sitting position under interscalene block. Anesth Analg. 1998;87(6):1320–1325.
    1. Lim J-K, Ang K-C, Wang S-C, Kumar VP. Rhabdomyolysis following shoulder arthroscopy. Arthroscopy. 2006;22(12):1366.e1–5.
    1. Manjuladevi M, Gupta S, Upadhyaya KV, Kutappa AM. Postoperative airway compromise in shoulder arthroscopy: a case series. Indian J Anaesth. 2013;57(1):52–55.
    1. Matthews LS, Fadale PD. Subacromial anatomy for the arthroscopist. Arthroscopy. 1989;5(1):36–40.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG. Reprint--Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. Phys Ther. 2009;89(9):873–880.
    1. Morrison DS, Schaefer RK, Friedman RL. The relationship between subacromial space pressure, blood pressure, and visual clarity during arthroscopic subacromial decompression. Arthroscopy. 1995;11(5):557–560.
    1. Orebaugh SL. Life-threatening airway edema resulting from prolonged shoulder arthroscopy. Anesthesiology. 2003;99(6):1456–1458.
    1. Ozhan MO, Suzer MA, Cekmen N, Caparlar CO, Eskin MB. Tracheal compression during shoulder arthroscopy in the beach-chair position. Curr Ther Res Clin Exp. 2010;71(6):408–415.
    1. Pohl A, Cullen DJ. Cerebral ischemia during shoulder surgery in the upright position: a case series. J Clin Anesth. 2005;17(6):463–469.
    1. Pope D, Wottowa C. Mixed neuropathy presenting clinically as an anterior interosseous nerve palsy following shoulder arthroscopy: a report of four cases. J Shoulder Elbow Surg. 2016;25(10):1699–1703.
    1. Rains DD, Rooke GA, Wahl CJ. Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy. Arthroscopy. 2011;27(4):532–541.
    1. Saeki N, Kawamoto M. Tracheal obstruction caused by fluid extravasation during shoulder arthroscopy. Anaesth Intensive Care. 2011;39(2):317–318.
    1. Sharma M, Achar SK. Airway oedema during shoulder arthroscopy: how we played it safe! Indian J Anaesth. 2013;57(3):319–320.
    1. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological Index for Non-Randomized Studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73(9):712–716.
    1. Smith CD, Shah MM. Fluid gain during routine shoulder arthroscopy. J Shoulder Elbow Surg. 2008;17(3):415–417.
    1. Sperber A, Wredmark T. Intramuscular pressure and fluid absorption during arthroscopic acromioplasty. J Shoulder Elbow Surg. 1999;8(5):414–418.
    1. Venkat G, Moon YL, Na WC, So KY. Upper airway compromise by extravasated fluid: a rare complication after arthroscopic repair of atrophic cuff tear. Orthopedics. 2009;32(10):776–778.
    1. Wright JG. Levels of evidence and grades of recommendations. Available at: . Accessed December 20, 2015.
    1. Yoshimura E, Yano T, Ichinose K, Ushijima K. Airway obstruction involving a laryngeal mask airway during arthroscopic shoulder surgery. J Anesth. 2005;19(4):325–327.

Source: PubMed

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