title: Change in neck circumference after shoulder arthroscopy: An observational study.
abstract: OBJECTIVE
  Shoulder arthroscopy requires fluid irrigation, which causes soft-tissue oedema around chest, neck, and arm intraoperatively, leading to postoperative airway complications. We decided to study the incidence of increase in the neck circumference in shoulder arthroscopy and its effects on the airway.
  
  
  METHODS
  We studied 32 cases of shoulder arthroscopies over a period of 1-year, performed under general anaesthesia with interscalene block. The neck circumference of patients before and after the procedure was measured along with other parameters. The endotracheal tube cuff was deflated at the end of surgery to determine air leak around the tube. The negative leak test suggested airway oedema.
  
  
  RESULTS
  Thirty out of 32 patients showed positive air leak test. The average change in neck circumference was 1.17 ± 1.16 cm and all could be extubated uneventfully. Two showed negative leak test with an increase in neck circumference by 4.5 and 6.4 cm and were not extubated. Multiple regression analysis for risk factors showed intraoperative hypertension as a single predictor for an increase in neck circumference.
  
  
  CONCLUSIONS
  Change in the neck circumference beyond 4 cm may suggest airway compromise and below 4 cm, airway compromise is unlikely even in the presence of extensive soft-tissue oedema around the shoulder, upper arm and chest.
authors.affiliation: Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India.
authors.forename: Shrividya
authors.initials: S
authors.lastname: Chellam
authors.affiliation: Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India.
authors.forename: Sheetal
authors.initials: S
authors.lastname: Chiplonkar
authors.affiliation: Department of Anaesthesia, BARC Hospital, Mumbai, Maharashtra, India.
authors.forename: Ketaki
authors.initials: K
authors.lastname: Pathak
keywords: Airway oedema; saline extravasation; shoulder arthroscopy