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Tracheal compression during shoulder arthroscopy in the beach-chair position

机译：沙滩椅位置的肩关节镜检查期间气管压迫

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Background: Respiratory distress is a rare complication of outpatient shoulder arthroscopy and mostly associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis. Objective: We report on a shoulder arthroscopy complicated by tracheal compression caused by extravasation of irrigation fluid into soft tissues of the upper airway while the patient was in the beach-chair position under general anesthesia.Case Summary: A 33-year-old male was scheduled for shoulder arthroscopy for impingement syndrome of the right shoulder under general anesthesia combined with interscalene brachial plexus block. During the operation, the patient's neck, right chest, and shoulder were observed to be swollen and tense on palpation. A fiberoptic bronchoscopic evaluation through the endotracheal tube revealed that the trachea was compressed to the left, but not completely obstructed. It was determined that the irrigation fluid had leaked subcutaneously from the shoulder joint to the neck. Vital signs were stable and the patient could be adequately ventilated despite the airway obstruction. The patient was transferred to the ward 16 hours after the operation with stable vital signs and discharged from the hospital on the second day. Conclusions: We report a case of airway obstruction due to tracheal compression from extravasation of irrigation fluid during shoulder arthroscopy under general anesthesia combined with peripheral nerve block in the beach-chair position. General anesthesia with endotracheal intubation protected the patient from a possibly fatal complication.
机译：背景：呼吸窘迫是门诊肩关节镜检查的罕见并发症，主要与全身麻醉，气胸，过敏性反应或神经麻痹有关。目的：我们报道了在全身麻醉下处于沙滩椅位置时，肩关节镜并发气管压迫并导致冲洗液渗入上呼吸道软组织而导致的气管压缩的病例。计划在全身麻醉下联合斜肌肌间臂丛神经阻滞进行肩关节镜检查以治疗右肩撞击综合征。在手术中，观察到患者的颈部，右胸和肩膀在触诊时肿胀和紧张。通过气管插管的纤维支气管镜评估显示，气管被压缩到左侧，但并未完全阻塞。已确定冲洗液已从肩关节皮下泄漏到颈部。生命体征稳定，尽管气道阻塞，患者仍可充分通风。手术后16小时，患者被转移到病房，生命体征稳定，第二天从医院出院。结论：我们报告了一例在全身麻醉下在沙滩椅位置肩关节镜下结合周围神经阻滞而因冲洗液外渗引起的气管压迫导致气道阻塞的病例。气管插管全麻可保护患者免于致命的并发症。

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