Tracheal compression during shoulder arthroscopy in the beach-chair position

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Patient Safety

Background:

• Respiratory distress is a rare complication of outpatient shoulder arthroscopy.
• It is typically associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis.

Purpose of the Study:

• To report a case of tracheal compression caused by irrigation fluid extravasation during shoulder arthroscopy.
• To highlight the protective role of general anesthesia with endotracheal intubation.

Main Methods:

• A 33-year-old male underwent shoulder arthroscopy for impingement syndrome under general anesthesia and interscalene brachial plexus block.
• Subcutaneous extravasation of irrigation fluid led to neck and chest swelling and tracheal compression.
• Fiberoptic bronchoscopy confirmed partial tracheal obstruction.

Main Results:

• The patient experienced tracheal compression due to fluid extravasation into the neck.
• Despite airway obstruction, vital signs remained stable, and ventilation was adequate.
• The patient was discharged on postoperative day two with stable vital signs.

Conclusions:

• Airway obstruction can occur from irrigation fluid extravasation during shoulder arthroscopy in the beach-chair position.
• General anesthesia with endotracheal intubation is crucial for managing such airway complications.
• This case underscores the importance of vigilance for rare complications in outpatient procedures.