title: Upper airway compromise by extravasated fluid: a rare complication after arthroscopic repair of atrophic cuff tear.
abstract: During arthroscopic procedures, leakage of irrigation fluid into surrounding tissue planes is a frequently noticed phenomenon usually clinically asymptomatic and resolving within 12 hours postoperatively. Although rare, this fluid may produce life-threatening complications such as airway compromise. This article describes a case of upper airway obstruction in a 60-year-old man undergoing arthroscopic repair for an atrophic rotator cuff tear. The patient presented with a 6-month history of pain and weakness in the left shoulder. Magnetic resonance imaging studies revealed a massive rotator cuff tear with significant retraction and fatty degeneration of cuff musculature. Perioperatively, all vital cardiorespiratory parameters were within normal limits. Postoperatively, immediately on extubation, he was dyspneic, and examination revealed a diffuse swelling extending from the left shoulder up to the neck and face. He was reintubated and sent to the recovery room, where he recovered 12 hours later. This article highlights the possibility of respiratory compromise due to the extravasation of irrigation fluid into the neck and chest during arthroscopic repair of massive and atrophied cuff tears, even with shorter surgical time as is this case. The widened suprascapular space will offer less resistance to the spread of fluid into the neck and chest from the shoulder. We advocate monitoring the patient continuously to prevent this serious complication from becoming life-threatening.
authors.affiliation: Chosun University Hospital, Gwangju, South Korea.
authors.forename: Gorthi
authors.initials: G
authors.lastname: Venkat
authors.forename: Young Lae
authors.initials: YL
authors.lastname: Moon
authors.forename: Woong Chae
authors.initials: WC
authors.lastname: Na
authors.forename: Keum Young
authors.initials: KY
authors.lastname: So
mesh_terms: D000402:Airway Obstruction / Q000209:etiology* / Q000503:physiopathology; D001182:Arthroscopy / Q000009:adverse effects*; D001284:Atrophy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011654:Pulmonary Edema / Q000209:etiology* / Q000503:physiopathology; D016059:Range of Motion, Articular; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012785:Shoulder Joint / Q000473:pathology / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery*