Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases.
We routinely have performed arthroscopic shoulder surgery under general anesthesia in the beach chair position using epinephrine (0.33 mg/L) saline irrigation. At a 2-week interval, two patients, a 19-year-old man scheduled to undergo an arthroscopic Bankart repair for left traumatic anterior instability and a 49-year-old woman scheduled for an arthroscopic rotator cuff repair for a left rotator cuff tear, were resuscitated by chest compression and defibrillation due to a sudden developed cardiogenic shock following ventricular tachycardia at the time of arthroscopic shoulder surgery. They were transferred to the intensive care unit because their emergent echocardiogram showed significantly decreased cardiac functions. They were fully recovered and then discharged. Epinephrine was considered to be the cause of ventricular tachycardia because the two patients showed no anaphylactic reaction to drugs or symptoms of air embolism related to the beach chair position. In addition, according to our observation of epinephrine flow patterns, it was more likely that highly concentrated epinephrine was rapidly infused into the body. This complication is very rare. However, thorough understanding of the side effects and their development of epinephrine during arthroscopic shoulder surgery should neither be overemphasized nor disregarded.
Cho
Seung Hyun
SH
Shoulder and Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul, Korea.
Yi
Jin Woong
JW
Kwack
Yoon Ho
YH
Park
Sung Wook
SW
Kim
Mi Kyeong
MK
Rhee
Yong Girl
YG
D001182:Arthroscopy; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007431:Intraoperative Complications; D007593:Joint Instability / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D012782:Shoulder / Q000601:surgery*; D017180:Tachycardia, Ventricular / Q000209:etiology*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000009:adverse effects; D055815:Young Adult
D014662:Vasoconstrictor Agents; D004837:Epinephrine