Extravasation Of Irrigation Fluid Research Articles

AB136. SOH23ABS_122. Management of intraperitoneal bladder rupture with ultrasound guided percutaneous drain insertion: a case report

Background: Intraperitoneal rupture of the bladder is a rare but significant complication of transurethral resection of bladder tumour (TURBT) with a high degree of associated morbidity and mortality. These patients are also exposed to a significant risk of developing TURBT syndrome secondary to intraperitoneal extravasation of irrigation fluid resulting frequently in electrolyte imbalances. Conventional management of intraperitoneal bladder rupture consists of formal laparotomy and open surgical repair. There is growing interest in less invasive management of bladder perforation in haemodynamically stable patients. We present one such case of intraperitoneal bladder rupture which was successfully managed with percutaneous drain insertion under ultrasound guidance. Percutaneous drain insertion is a novel, minimally invasive approach which has proven successful in the management of uncomplicated intraperitoneal bladder perforation. Three cases successfully utilising this treatment modality have been reported in the literature to date. Despite being performed in many institutions, there is a clear lack of reporting in the literature. This case study aims to add to the growing body of research supporting the use of percutaneous drainage in the management of uncomplicated intraperitoneal bladder rupture.

Developing Subcutaneous Emphysema, Pneumothorax and Pneumomediastinum after Arthroscopic Shoulder Surgery under General Anesthesia: A Case Report

The use of arthroscopic shoulder surgery for diagnosis and treatment is increasing. Although some complications may occur during the operation, subcutaneous emphysema, pneumomediastinum and pneumothorax are rare complications. In this case, we present a patient who developed subcutaneous emphysema, pneumomediastinum and pneumothorax. A 53-year-old female patient presented with right shoulder pain for 8 months. The patient's body mass index is 20. Additional diseases are rheumatoid arthritis (RA) and vertigo. There was no other systemic disease or comorbidity. She was assigned an American Society of Anesthesiologists (ASA) score of 2. Arthroscopic rotator cuff repair was planned. She was operated under general anesthesia (GA). Subcutaneous emphysema, pneumothorax and pneumomediastinum developed at 6 hours after this surgery. The patient was discharged without any complaints on the 6th day of follow-up. No problem was detected in the follow-up of the patient. After shoulder arthroscopy under GA, subcutaneous emphysema, pneumothorax and pneumomediastinum can occur due to the procedure itself, the pleural and alveolar trauma, the endotracheal intubation or extravasation of irrigation fluid during shoulder arthroscopy. In our case, it was not possible to determine the exact cause. However, it is important to keep in mind that subcutaneous emphysema, pneumothorax and pneumomediastinum can occur after arthroscopic shoulder surgery. Although shoulder arthroscopy is a safe procedure, surgeon familiarity with the risk factors for this complication and close monitoring can aid in its identification and allow for appropriate treatment.

Intraoperative complications in temporomandibular joint arthroscopy: A retrospective observational analysis of 899 arthroscopies

This study aims to describe intraoperative complications in temporomandibular joint arthroscopy in patients with Wilkes stage II, III y IV. An analytic observational retrospective study. Inclusion criteria were patients who had no improvement with conservative treatment diagnosed as Wilkes II stage to Wilkes stage IV, and no previous TMJ surgery. Exclusion criteria were disc perforation observed by arthroscopy. Data collected from 458 patients (899 arthroscopies). Of this population, 772 (85.8%) arthroscopies correspond to women, and 127 men (14.1%). Of the sample evaluated, 368 (40.9%) were arthroscopic without discopexy, and 531 (59%) were arthroscopic with discopexy using resorbable pins. In total, 330 complications (36.7%) were found, of which 293 (32.5%) were implicated with iatrogenic damage to the anatomy, and 36 (4%) were associated with some instrument failure. Of this total number of complications, 191 (51.9%) of 386 corresponded to the arthroscopy without discopexy group and 138 (25.9%) of 531 corresponded to the arthroscopy with discopexy group. These study data suggest that the main complications were irrigation fluid extravasation (p = 0.000), and intra-articular bleeding (p = 0.001) followed by pin problems (p = 0.001) in cases of arthroscopies with discopexy. Within the limitations of the study it seems that the learning curve has an important influence on the occurrence of complications. At the beginning of the learning curve, complications are more related to anatomy. Afterwards, the rate of complications decreases but they are more related to the instruments used in advanced techniques. Therefore, proper training and a wide learning curve can reduce the risk of complications and if any occur, more timely management could be given.

Perirenal Extravasation After Retrograde Intrarenal Surgery for Renal Stones: A Prospective Study.

BackgroundThe incidence and consequences of the perirenal extravasation of the irrigation fluid during retrograde intrarenal surgery (RIRS) are not fully elucidated. The objective of this study was to assess the incidence, risk factors, and complications of perirenal extravasation of irrigation fluid during RIRS.MethodsThis prospective observational study was conducted in the Department of Urology, Bir Hospital, Kathmandu, Nepal, from January 2020 to March 2021. Patients undergoing RIRS for renal stones less than 2 cm in diameter were included in the study. Irrigation during the procedure was performed using isotonic normal saline under gravity at 50 cm from the symphysis pubis of patients with intermittent manual compression if required. Lithotripsy was performed with 120-Watt Ho:YAG laser using 200-micron laser fiber. Retrograde pyelogram was performed after the completion of lithotripsy to document the presence or absence of extravasation on fluoroscopic images. A double-J stent was placed at the end in all patients. Patients were observed for systemic inflammatory response syndrome (SIRS) features. Postoperative abdominal ultrasonography was performed on the first postoperative day to assess the perirenal collection together with complete blood count. The visual analogue scale (VAS) was used to assess pain in postoperative period. The preoperative patient’s and stone characteristics, hydronephrosis, intraoperative characteristics, and postoperative findings were analyzed.ResultsA total of 71 patients who underwent RIRS during the study period were analyzed. The mean (SD) stone size was 13.19 (3.12) mm. Intraoperative perirenal extravasation of contrast was noted in eight (11.26%) patients; however, no patient had ipsilateral perirenal collection on ultrasonography obtained on the first postoperative day. No significant differences were observed among patients with or without perirenal extravasation in terms of mean stone size, laser settings, operative duration, and lasing duration. Use of ureteral access sheath (UAS) was associated with lower incidence of extravasation; however, it was not significant. SIRS was documented in eight patients overall, with none of the patients with extravasation having features of SIRS. Patients with extravasation experienced more postoperative flank pain (p<0.05).ConclusionPerirenal extravasation was common during RIRS and was associated with higher postoperative pain scores. Stone size, use of UAS, laser settings, operative duration, and lasing duration were not associated with an increased risk of extravasation. Extravasation was not associated with increased postoperative complications.

A STUDY OF PERIOPERATIVE COMPLICATIONS AND ITS CORRELATION WITH AMOUNT OF IRRIGATION FLUID USED IN PATIENTS UNDERGOING SHOULDER ARTHROSCOPY

Introduction: Arthroscopic shoulder surgery is a minimally invasive technique performed for diagnostic and therapeutic purposes. Advances in arthroscopy permit many procedures to be performed primarily or adjunctively through the arthroscope. Commonest indications of shoulder arthroscopy is usually performed for Shoulder instability, Bankart’s lesion, Supraspinatus tear, Meniscus tear, Impingement syndrome, Rotator cuff tears, Calcific tendonitis tendinitis and Frozen shoulder. Recent evidences, however, have increasingly focused on complications related to use of irrigation fluid, patient positioning and anaesthesia during shoulder arthroscopy. The risk of complications can be reduced with an experienced surgeon, lesser surgical duration, use of controlled pump pressures and controlled flow rate of irrigation fluids.&#x0D; Material and Methods: The present prospective study involves an analysis of perioperative monitoring of effects of amount of irrigation fluid in patient undergoing shoulder arthroscopy. With objective to see the Effect of irrigation fluid absorption on measurable parameters and to identify whether these parameters help in predicting airway/ respiratory compromise or cardiac complications.All the patients of any ASA Grade, sex and above 18 years who were posted for shoulder arthroscopy were included in the study. 72 patients who were undergoing shoulder arthroscopy were invited to participate in this observational study. Complete histories were obtained and thorough clinical examination was carried out. Brachial plexus block with general anaesthesia were given to all the patients.&#x0D; Results: Out of 72 patients 54(75%) were males and 18(25%) were females.30 litres or less irrigation fluid is used in 47(65.3%) patients, between 30-40 litres is used in 24(33%) patients and 40 litres or more irrigation fluid is used in 1( 1.4%) patient. Baseline pulse rate was 79.85±8.11 per minutes, which started decreasing from T4 (1.4%) to throughout the procedure and this fall was found to be statistically significant. The maximum fall in pulse rate at 160 minutes (19.8%). Pulse rate increases from 200 minutes till the end of the surgery. Baseline mean BP was 101.63±7.90 mm Hg, which started decreasing from T1 (16.1%) to throughout the procedure and this fall was found to be statistically significant. the leak test and delayed extubation in patients undergoing shoulder arthroscopy. Towards the end of procedure and prior to extubation 4(5.6%) patients showed negative leak test and hence, had delayed extubation, and 68(94.4%) patients showed positive leak test and normal extubation and statistically significant. Mid arm circumference was increased by 14.2%, neck circumference was increased by 10.4%, haemoglobin (Hb) was decreased by 6.6%, serum sodium (Na) was decreased by 4.6% and serum potassium (K) was decreased by 16.2%. Post-operative changes in all these parameters was found to be statistically significant.&#x0D; Conclusion: Extravasation of irrigation fluid used during shoulder arthroscopy can be disastrous leading to various complications like airway oedema, tracheal compression extensive subcutaneous emphysema, pneumomediastinum, tension pneumothorax and air embolism. The risk of regional and systemic absorption of irrigation fluid is directly proportional to amount of irrigation fluid used and duration of surgery. The measurement of neck circumference can be a clinical predictor for airway oedema following shoulder arthroscopy. We recommend to with hold extubation when the neck circumference increases by more than 6 cm

Abdominal compartment syndrome during hip arthroscopy for an acetabular fracture: a case report

BackgroundWe encountered a case of abdominal compartment syndrome during hip arthroscopic surgery, caused by the irrigation fluid flowing into the peritoneal cavity.Case presentationA 47-year-old male patient with the acetabulum fracture underwent open reduction and internal fixation with hip arthroscopy. Hypothermia, increased airway pressure (under volume-controlled ventilation) and oliguria were observed during the operation, and arterial blood gas analysis showed decreased oxygenation and metabolic acidosis. Abdominal distention was observed, and a postoperative CT revealed accumulation of a large volume of irrigation fluid in the peritoneal cavity and retroperitoneum. The patient was diagnosed as having abdominal compartment syndrome and treated by percutaneous peritoneal drainage. His subsequent course was uneventful, and he was discharged 8 weeks after the operation. Intraperitoneal extravasation of irrigation fluid may occur during hip arthroscopic surgery, and is more likely to occur in the presence of an injury.ConclusionAnesthesiologists should be aware of the possible occurrence of the abdominal compartment syndrome during hip arthroscopic surgery and ensure that it is detected early.

Anesthesia for hip arthroscopy: a narrative review.

Hip arthroscopy is a minimally invasive surgical procedure indicated for the treatment of specific hip disorders. In this narrative review, we aim to examine the key components in providing anesthesia for this procedure. MEDLINE(®), PubMed, and EMBASE™ databases were searched for peer-reviewed articles discussing the anesthetic management of patients undergoing hip arthroscopy. The primary anesthetic regimen used for hip arthroscopy should balance patient factors, preferences of the surgeon, and the demands of the procedure itself. Both general and neuraxial anesthetic techniques are well suited for this mostly ambulatory surgical procedure. There is a lack of current literature specifically comparing the benefits and risks of the two techniques in this setting. Postoperative pain management consists mainly of intravenous and oral opioids; however, a variety of regional anesthesia techniques, such as lumbar plexus block and fascia iliaca block, can be performed pre- or postoperatively. Overall, hip arthroscopy is safe, although positioning-related difficulties, extravasation of irrigation fluid, hypothermia, infections, and thromboembolic events are potential perioperative complications that warrant specific monitoring and prompt treatment. Until now, the anesthetic technique for hip arthroscopy has not been well studied. Thus, increasing emphasis should be directed towards examining relevant clinical outcomes that can better inform evidence-based decision-making in the anesthetic management of hip arthroscopy patients. In the meantime, awareness of potential complications and vigilant monitoring are paramount in providing safe anesthetic care for patients undergoing hip arthroscopy.

Complications of temporomandibular joint arthroscopy using two-portal coblation technologies: A prospective study of 475 procedures

To study the complications of temporomandibular joint (TMJ) arthroscopic procedures using two-portal coblation technologies. The 397 consecutive patients (475 joints) who underwent arthroscopic surgery were prospectively analyzed. Complications were observed in 39 (8.21%) procedures. Complications recognized during or immediately after surgery were observed in 25 cases (5.26%). Vascular injury in the points of trocar insertion was observed in seven cases. Lesions of the fibrocartilage layer of the joint secondary to introduction of instruments were observed in 12 cases. Bleeding within the superior joint space was observed in 21 cases. Extravasation of irrigation fluid appeared in five patients, affecting the oropharyngeal space in one case. In 20 patients, more than one complication at the time of surgery occurred. Delay postoperative complications were noted in 14 patients. Blood clots in the external auditory canal were found in eight cases and lacerations in two cases. One patient experienced partial hearing loss, and two patients experienced vertigo. Temporary hypoesthesia of the auriculotemporal nerve was seen in two patients. Temporary damage to the V cranial nerve was observed in four patients. Temporary paralysis of the zygomatic branch of the facial nerve was seen in one patient. TMJ arthroscopy using coblation technologies is a safe surgical procedure when performed by experienced surgeons.

Effects of irrigation fluid in shoulder arthroscopy.

Background and Aims:Extravasation of irrigation fluid used in shoulder arthroscopy can lead to life-threatening airway and systemic complications. This study was conducted to assess the effect of irrigation fluid absorption on measurable anthropometric parameters and to identify whether these parameters predict airway/respiratory compromise.Methods:Thirty six American Society of Anaesthesiologists physical status one or two patients aged 15–60 years undergoing shoulder arthroscopy under general anaesthesia were recruited. Measured variables preoperatively (baseline) and at the end of surgery were neck, chest, midarm and midthigh circumferences, weight, haemoglobin and serum sodium. Temperature, endotracheal tube cuff pressure, airway pressure, duration of surgery, amount of irrigation fluid and intravenous fluid used were also noted. Measured parameters were correlated with the duration of surgery and the amount of irrigation fluid used.Results:Postoperatively, the changes in variables showed a significant increase in the mean values (cm) for neck, chest, midarm and midthigh circumference (mean ± standard deviation: 2.35 ± 1.9, P < 0.001; 2.9 ± 3.88 cm, P < 0.001; 3.28 ± 2.44, P < 0.001 and 0.39 ± 0.71, P = 0.002, respectively) and weight (kg) (1.17 ± 1.24, P < 0.001). The post-operative haemoglobin (g/dL) levels decreased significantly (0.89 ± 1.23, P < 0.001) as compared to the baseline. No significant change was found in the serum sodium levels (P = 0.92). No patient experienced airway/respiratory compromise.Conclusion:Regional and systemic absorption of irrigation fluid in arthroscopic shoulder surgery is reflected in the degree of change in the measured anthropometric variables. However, this change was not significant enough to cause airway/respiratory compromise.

Shoulder arthroscopy and complications: Can we afford to relax?

Shoulder arthroscopy and complications: Can we afford to relax?

Massive Proximal Extravasation as a Complication during Arthroscopic Anterior Cruciate Ligament Reconstruction

Extra-articular extravasation of irrigation fluid is relatively common around entry incisions and is usually limited to the subcutaneous tissue. Very rarely, extravasation occurs above the knee, in the thigh and even up into the pelvis. We are reporting the second case of irrigation fluid extravasation during a knee arthroscopy, which spread up to the thigh, groin and perineum during anterior cruciate ligament reconstruction, whilst the tourniquet was inflated. In our case, we think that the extravasation was caused by a fault in the pressure sensor due to the fact that the reservoir was over-filled. The irrigation pressure was therefore too high, and the irrigation fluid was able to diffuse, despite the presence of a pneumatic tourniquet, up past the thigh.

Airway compression after arthroscopic shoulder surgery under general anesthesia

Airway compression after arthroscopic shoulder surgery under general anesthesia

Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy

Airway compromise due to irrigation fluid extravasation following shoulder arthroscopy

Transurethral Resection Syndrome Caused by Bladder Perforation during Transurethral Resection of Bladder Tumor: A Report of 2 Cases

Transurethral resection (TUR) of bladder tumor may be complicated with bladder perforation associated with intraperitoneal and retroperitoneal extravasation of irrigation fluid, which may rarely evolve in specific hydroelectrolyte imbalance characterized with hyponatremia, intravascular volume deficit, and renal impairment. Signs and symptoms of cardiovascular dysfunction secondary to hyponatremia, prolonged resection, and intravascular volume deficit may also occur, such as severe hypotension, bradycardia, and cardiac arrest. It is most important to prevent TUR syndrome by using an accurate technique. If bladder perforation occurs, early detection is important for the appropriate treatment.

Tracheal compression during shoulder arthroscopy in the beach-chair position

Background: Respiratory distress is a rare complication of outpatient shoulder arthroscopy and mostly associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis. Objective: We report on a shoulder arthroscopy complicated by tracheal compression caused by extravasation of irrigation fluid into soft tissues of the upper airway while the patient was in the beach-chair position under general anesthesia. Case Summary: A 33-year-old male was scheduled for shoulder arthroscopy for impingement syndrome of the right shoulder under general anesthesia combined with interscalene brachial plexus block. During the operation, the patient's neck, right chest, and shoulder were observed to be swollen and tense on palpation. A fiberoptic bronchoscopic evaluation through the endotracheal tube revealed that the trachea was compressed to the left, but not completely obstructed. It was determined that the irrigation fluid had leaked subcutaneously from the shoulder joint to the neck. Vital signs were stable and the patient could be adequately ventilated despite the airway obstruction. The patient was transferred to the ward 16 hours after the operation with stable vital signs and discharged from the hospital on the second day. Conclusions: We report a case of airway obstruction due to tracheal compression from extravasation of irrigation fluid during shoulder arthroscopy under general anesthesia combined with peripheral nerve block in the beach-chair position. General anesthesia with endotracheal intubation protected the patient from a possibly fatal complication.

Intrathoracic Fluid Extravasation After Hip Arthroscopy

The case of intrathoracic extravasation of irrigation fluid after hip arthroscopy in a 21-year-old woman is presented. In this patient intraperitoneal and retroperitoneal fluid collection developed, as seen in other case reports documenting irrigation fluid extravasation during hip arthroscopy. The patient presented to the emergency department on the first postoperative day complaining of shortness of breath. Computed tomography of the chest, abdomen, and pelvis showed retroperitoneal fluid, extensive abdominal ascites, and bilateral pleural effusions within the chest. The fluid diminished pulmonary volume by elevating the diaphragm and causing compression atelectasis of both lungs. The patient's hemodynamic status was stable and unaffected. She developed hypothermia during the procedure, which is consistent with other reports on extravasated irrigation fluid during arthroscopy. She was able to rapidly compensate for fluid overload and eliminated it uneventfully, with resolution of her symptoms. A similar procedure was performed on the contralateral hip 6 months later. During that procedure, there was a suspected (not confirmed) recurrence of intraperitoneal extravasation of the pump fluid as well as transient hypothermia, which resolved by the first postoperative visit. The physiologic effects of intrathoracic fluid accumulation and the literature regarding extravasation of irrigation fluid during hip arthroscopy are also reviewed.

Upper Airway Compromise by Extravasated Fluid: A Rare Complication After Arthroscopic Repair of Atrophic Cuff Tear

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.

Abdominal compartment syndrome during hip arthroscopy

Hip arthroscopy is recognised as a highly effective means of treating joint disorders. The majority of complications associated with hip arthroscopy involve neurovascular traction injury. We report a relatively unusual complication of hip arthroscopy, extravasation of irrigation fluid into the retroperitoneal and intraperitoneal cavities, resulting in abdominal compartment syndrome.

Pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery: A case report.

Arthroscopic shoulder surgery has become a common and routine procedure because it provides several advantages for the diagnosis and therapy of shoulder injuries. However, shoulder arthroscopy is not a technique that's void of complications. We describe here a unique case of a patient who experienced pleural effusion caused by extravasation of irrigation fluid during arthroscopic shoulder surgery, and this surgery was done under general anesthesia.

Case Report Accumulation of Irrigation Fluid in the Calf as a Complication During High Tibial Osteotomy Combined With Simultaneous Arthroscopic Anterior Cruciate Ligament Reconstruction

Summary: Extravasation of irrigation fluid during arthroscopy is a well-known complication. We report a case of accumulation of fluid into the calf during open wedge high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament (ACL) reconstruction. The main cause for fluid extravasation was the drilling of the tibial tunnel, which allowed the fluid to cross the osteotomy gap and invade the flexor compartments. Although an elevation of the intracompartmental pressure was measured, there was no clinical evidence of compartment syndrome. A subcutaneous release of the flexor compartment of the leg was performed. The patient suffered no further sequelae. High tibial osteotomy combined with simultaneous arthroscopic ACL reconstruction has to be performed carefully, and potential complications must be detected immediately to prevent compartment syndrome.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 15, No 8 (November), 1999: pp 864–866