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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.