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Reverse takotsubo cardiomyopathy induced by adrenaline-containing irrigation solution during shoulder arthroscopy
1Department of Anaesthesia Rabin Medical Centre, Beilinson Hospital Petah Tikva Israel.
Anaesthesia Reports
|July 10, 2023
Summary
Adrenaline in arthroscopic irrigation may cause takotsubo cardiomyopathy, a reversible heart condition. This case highlights cardiac risks associated with surgical adrenaline use.
Area of Science:
- Cardiology
- Anesthesiology
- Orthopedic Surgery
Background:
- Adrenaline in arthroscopic irrigation enhances surgical visibility by reducing bleeding.
- Systemic absorption of adrenaline during surgery poses a risk of cardiac complications.
- Takotsubo cardiomyopathy involves reversible systolic dysfunction triggered by stress-induced vasospasm.
Observation:
- A patient developed ventricular arrhythmias and hemodynamic instability during shoulder arthroscopy with adrenaline irrigation.
- Echocardiography showed severe left ventricular dysfunction with basal ballooning, consistent with takotsubo cardiomyopathy.
- Coronary angiography revealed normal coronary arteries, ruling out obstructive coronary artery disease.
Findings:
- The patient experienced a reverse variant of takotsubo cardiomyopathy following arthroscopic surgery.
- Hemodynamic support and intensive cardiac care were required due to the cardiac event.
- Complete recovery of left ventricular function was observed within three months.
Implications:
- This case underscores the potential cardiac risks, including takotsubo cardiomyopathy, associated with adrenaline-containing irrigation solutions in arthroscopy.
- While rare, the increasing reports necessitate a review of the safety and judicious use of adrenaline in surgical irrigation.
- Clinicians should be vigilant for cardiac complications in patients exposed to systemically absorbed adrenaline during surgical procedures.
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