Fluid Management for Shoulder Arthroscopy:

- Fluid Management:
     
- need for continuous outflow;
             - note that a small amount of continuous outflow will allow for clear visualization and decreased inflow pressure settings;
             - Bernoulli principle: bleeding can be decreased by decreased fluid turbulence due to egress of fluid from portal sites;
             - note that continuous outflow will allow reduced pump pressure (and less extravasation) while still allowing for visualization;
             - if dedicated outflow pump is not available, then apply IV tubing to the "outflow" portion of the plastic cannula;
             - outflow should be slightly more than a fast drip;
             - avoid using the suction on the shaver, or reduce its use as much as possible;
        - addition of epinephrine to fluid:
             - standard dose: 1 mg epi per 3 liter bag (0.33 mg/liter);
             - be aware that large areas of exposed bleeding bone (acromionplasty and distal clavicle excision) are a conduit to blood stream.
             - references:
                    - Addition of Epinephrine to Irrigation Fluid During Arthroscopic Surgery Reduced Bleeding and Increased Visualization
                    - Effects of Adding Epinephrine to Arthroscopic Irrigation Fluid on Cultured Chondrocyte Survival In Vitro
                    - Arthroscopic shoulder surgery with epinephrine saline irrigation
                    - Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report.
                    - The effect of norepinephrine versus epinephrine in irrigation fluid on the incidence of hypotensive/bradycardic events during arthroscopic rotator cuff repair with interscalene block in the sitting position.

             - complications:

                    - Fatal Venous Air Embolism During Shoulder Arthroscopy. A Case Report
                    - Activation of the Bezold-Jarisch reflex in the sitting position for shoulder arthroscopy using interscalene block.
                    - Commercial Liquid Bags as a Potential Source of Venous Air Embolism in Shoulder Arthroscopy
                    - Ventricular tachycardia during arthroscopic shoulder surgery: a report of two cases
                    - Epinephrine-induced potentially lethal arrhythmia during arthroscopic shoulder surgery: a case report.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Friday, June 24, 2016 10:46 am