Pathomechanisms and Complications Related to Patient Positioning and Anesthesia During Shoulder Arthroscopy
| Autor: | Christopher J. Wahl, G. Alec Rooke, Derek D. Rains |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Risk
medicine.medical_specialty Shoulder surgery medicine.medical_treatment Posture Hypotension Controlled Quadriplegia Ventricular tachycardia Patient Positioning Arthroscopy Postoperative Complications Ischemia Peripheral Nerve Injuries Evoked Potentials Somatosensory Monitoring Intraoperative mental disorders medicine Lateral Decubitus Position Humans Anesthesia Orthopedics and Sports Medicine Intraoperative Complications Therapeutic Irrigation Anesthetics Shoulder Joint business.industry Peripheral Nervous System Diseases Pneumothorax Neurapraxia medicine.disease Surgery Airway Obstruction Solutions Airway Compromise Spinal Cord Cardiovascular Diseases Anesthetic Brain Damage Chronic Brachial Plexopathy business human activities medicine.drug |
| Zdroj: | Arthroscopy: The Journal of Arthroscopic & Related Surgery. 27:532-541 |
| ISSN: | 0749-8063 |
| Popis: | The lateral decubitus and beach-chair positions each offer unique benefits to the shoulder surgeon with respect to visualization, efficiency, and ease during arthroscopic shoulder procedures. The purpose of this article was to comprehensively review the reports and studies documenting independent and dependent complications related to patient positioning and anesthesia during arthroscopic shoulder surgery. The lateral decubitus position has been associated with the potential for peripheral neurapraxia, brachial plexopathy, direct nerve injury, and airway compromise. The beach-chair position has been associated with cervical neurapraxia, pneumothorax, and the potential for end-organ hypoperfusion injuries (when deliberate hypotension is used). Potentially concerning are hypotensive bradycardic events, which may be relatively common in association with the use of epinephrine-containing interscalene anesthetics in beach chair-positioned patients. Irrigant complications (fluid spread, ventricular tachycardia) are avoidable risks not unique to either specific position. Although minor transient anesthetic- and position-related complications (neurapraxia, hypotension) may occur in as many 10% to 30% of patients, major complications such as end-organ damage or permanent impairments are exceedingly rare. Regardless of position, complications are almost uniformly avoidable if surgeon and anesthetist exercise care and prudent attention to position and anesthetic choices. The purpose of this article is to review the potential for position- and anesthesia-related complications and acquaint the shoulder surgeon with the proposed pathophysiologic mechanisms that can lead to them. |
| Databáze: | OpenAIRE |
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