全麻沙滩椅位肩关节镜手术并发症及预防措施概述
摘要
<正>经过数十年发展,肩关节镜手术逐渐成为运动医学中解决肩部疾患的首要方式。沙滩椅位因具有简易的摆放方式、良好的手术视野、较少的臂丛牵拉伤等优势成为医生首选。沙滩椅位手术时间相对较长,术中需控制性降压以维持术野清晰,现主要采用全身麻醉。全麻沙滩椅位肩关节镜在获得良好手术效果的同时,越来越多相关并发症如神经损伤、脑缺血、栓塞事件逐渐进入人们视野,尽管发生率低,但后果通常极其严重。医生只有采取积极有效的并发症预防措施,才
引文
[1]Iqbal S,Jacobs U,Akhtar A,et al.A history of shoulder surgery[J].Open Orthop J,2013,7:305-309.
[2]Mannava S,Jinnah A H,Plate J F,et al.Basic shoulder arthroscopy:beach chair patient positioning[J].Arthrosc Tech,2016,5(4):731-735.
[3]Provencher C M T,McIntire E S,Gaston T M,et al.Avoiding complications in shoulder arthroscopy:pearls for lateral decubitus and beach chair positioning[J].Tech Shoulder Elbow Surgery,2010,11(1):1-3.
[4]Terry M A,Altchek D W.Diagnostic Shoulder Arthroscopy Technique:Beach Chair Position[M].Shoulder Arthroscopy.New York,NY,2003:9-15.
[5]Sulaiman L,Macfarlane R J,Waseem M.Current concepts in anaesthesia for shoulder surgery[J].Open Orthop J,2013,7:323-328.
[6]Morrison D S,Schaefer R K,Friedman R L.The relationship between subacromial space pressure,blood pressure,and visual clarity during arthroscopic subacromial decompression[J].Arthroscopy,1995,11(5):557-560.
[7]Gillespie R,Shishani Y,Streit J,et al.The safety of controlled hypotension for shoulder arthroscopy in the beachchair position[J].J Bone Joint Surg Am,2012,94(14):1284-1290.
[8]Kohn L T,Corrigan J M,Donaldson M S.To err is human:Building a safer health system[J].J Interprofessional Care,2002,16(4):413-416.
[9]Dove P,Gilmour F,Weightman W M,et al.Patient perceptions of regional anesthesia:Influence of gender,recent anesthesia experience,and perioperative concerns[J].Reg Anesth Pain Med,2011,36(4):332-335.
[10]Wu C L,Rouse L M,Chen J M,et al.Comparison of postoperative pain in patients receiving interscalene block or general anesthesia for shoulder surgery[J].Orthopedics,2002,25(1):45-48.
[11]Wilder B L.Hypothesis:the etiology of midcervical quadriplegia after operation with the patient in the sitting position[J].Neurosurgery,1982,11(4):530-531.
[12]Park T S,Kim Y S.Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy[J].Arthroscopy,2005,21(5):631.
[13]Rains D D,Rooke G A,Wahl C J.Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy[J].Arthroscopy,2011,27(4):532-541.
[14]Rhee Y G,Cho N S.Isolated unilateral hypoglossal nerve palsy after shoulder surgery in beach-chair position[J].JShoulder Elbow Surg,2008,17(4):28-30.
[15]Holtzman A J,Glezos C D,Feit E J,et al.Prevalence and risk factors for lateral femoral cutaneous nerve palsy in the beach chair position[J].Arthroscopy,2017,33(11):1958-1962.
[16]Moen T C,Rudolph G H,Caswell K,et al.Complications of shoulder arthroscopy[J].J Am Acad Orthop Surg,2014,22(7):410-419.
[17]Jerosch J,Filler T J,Peuker E T.Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?[J].Knee Surg Sports Traumatol Arthrosc,2002,10(2):126-129.
[18]Boykin R E,Friedman D J,Zimmer Z R,et al.Suprascapular neuropathy in a shoulder referral practice[J].JShoulder Elbow Surg,2011,20(6):983-988.
[19]Paxton E S,Backus J,Keener J,et al.Shoulder arthroscopy:basic principles of positioning,anesthesia,and portal anatomy[J].J Am Acad Orthop Surg,2013,21(6):332-342.
[20]Jeong H,Lee S H,Jang E A,et al.Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia[J].Acta Anaesthesiol Scand,2012,56(7):872-879.
[21]Murphy G S,Szokol J W,Marymont J H,et al.Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions[J].Anesth Analg,2010,111(2):496-505.
[22]Cox R M,Jamgochian G C,Nicholson K,et al.The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position:Arandomized blinded study[J].J Shoulder Elbow Surg,2018,27(4):692-700.
[23]Sia S.Hypotensive technique and sitting position in shoulder surgery[J].Anesth Analg,2003,97(4):1198.
[24]Fuchs G,Schwarz G,Kulier A,et al.The influence of positioning on spectroscopic measurements of brain oxygenation[J].J Neurosurg Anesthesiol,2000,12(2):75-80.
[25]Truijen J,Kim Y S,Krediet C T,et al.Orthostatic leg blood volume changes assessed by near-infrared spectroscopy[J].Exp Physiol,2012,97(3):353-361.
[26]Lee J H,Min K T,Chun Y M,et al.Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery[J].Arthroscopy,2011,27(7):889-894.
[27]Aguirre J A,Etzensperger F,Brada M,et al.The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension:Impact on cerebral oxygenation,cerebral blood flow and neurobehavioral outcome[J].J Clin Anesth,2019,53:40-48.
[28]Pohl A,Cullen D J.Cerebral ischemia during shoulder surgery in the upright position:A case series[J].J Clin Anesth,2005,17(6):463-469.
[29]Salazar D,Sears B W,Aghdasi B,et al.Cerebral desaturation events during shoulder arthroscopy in the beach chair position:Patient risk factors and neurocognitive effects[J].J Shoulder Elbow Surg,2013,22(9):1228-1235.
[30]Koh J L,Levin S D,Chehab E L,et al.Neer Award 2012:Cerebral oxygenation in the beach chair position:Aprospective study on the effect of general anesthesia compared with regional anesthesia and sedation[J].J Shoulder Elbow Surg,2013,22(10):1325-1331.
[31]Drummond J C,Lee R R,Howell J P Jr.Focal cerebral ischemia after surgery in the"beach chair"position:The role of a congenital variation of circle of Willis anatomy[J].Anesth Analg,2012,114(6):1301-1303.
[32]Salazar D,Hazel A,Tauchen A J,et al.Neurocognitive deficits and cerebral desaturation during shoulder arthroscopy with patient in beach-chair position:A review of the current literature[J].Am J Orthop,2016,45(3):63-68.
[33]Cox R M,Jamgochian G C,Nicholson K,et al.The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position:Arandomized blinded study[J].J Shoulder Elbow Surg,2018,27(4):692-700.
[34]Cardim D,Robba C,Matta B,et al.Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach[J].J Clin Monit Comput,2018:1-11.
[35]Calvisi V,Lupparelli S,Rossetti S.Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block:A case report and review of the literature[J].Arch Orthop Trauma Surg,2009,129(3):349-352.
[36]Marrero L G,Nelman K R,Nottage W M.Long-term follow-up of arthroscopic rotator cuff repair[J].Arthroscopy,2011,27(7):885-888.
[37]Randelli P,Castagna A,Cabitza F,et al.Infectious and thromboembolic complications of arthroscopic shoulder surgery[J].J Shoulder Elbow Surg,2010,19(1):97-101.
[38]Dodson C C,Craig E V,Cordasco F A,et al.Propionibacterium acnes infection after shoulder arthroplasty:A diagnostic challenge[J].J Shoulder Elbow Surg,2010,19(2):303-307.
[39]Millett P J,Yen Y M,Price C S,et al.Propionibacterium acnes infection as an occult cause of postoperative shoulder pain:A case series[J].Clin Orthop Relat Res,2011,469(10):2824-2830.
[40]Jameson S S,James P,Howcroft D W,et al.Venous thromboembolic events are rare after shoulder surgery:Analysis of a national database[J].J Shoulder Elbow Surg,2011,20(5):764-770.
[41]Levy B J,Tauberg B M,Holtzman A J,et al.Reducing lateral femoral cutaneous nerve palsy in obese patients in the beach chair position:effect of a standardized positioning and padding protocol[J].J Am Acad Orthop Surg,2018:Oct 15.
[42]Mazzon D,Danelli G,Poole D,et al.Beach chair position,general anesthesia and deliberated hypotension during shoulder surgery:A dangerous combination![J].Minerva Anestesiol,2009,75(5):281-282.
[43]Stecco C,Gagliano G,Lancerotto L,et al.Surgical anatomy of the axillary nerve and its implication in the transdeltoid approaches to the shoulder[J].J Shoulder Elbow Surg,2010,19(8):1166-1174.
[44]Yoo J C,Kim J H,Ahn J H,et al.Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position:A cadaveric study[J].Arthroscopy,2007,23(12):1271-1277.
[45]Gabriel R A,Beverly A,Dutton R P,et al.Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia:A retrospective analysis of 23,073patients[J].JClin Monit Comput,2017,31(5):877-884.
[46]Woo J H,Kim Y J,Jeong J S,et al.Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position:A randomized controlled trial[J].Korean J Anesthesiol,2018,71(2):127-134.
[47]Isley M R,Edmonds H L,Stecker M,et al.Guidelines for intraoperative neuromonitoring using raw(analog or digital waveforms)and quantitative electroencephalography:Aposition statement by the American Society of Neurophysiological Monitoring[J].J Clin Monit Comput,2009,23(6):369-390.
[48]Papadonikolakis A,Wiesler E R,Olympio M A,et al.Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position[J].Arthroscopy,2008,24(4):481-482.
[49]Saltzman M D,Nuber G W,Gryzlo S M,et al.Efficacy of surgical preparation solutions in shoulder surgery[J].J Bone Joint Surg Am,2009,91(8):1949-1953.
[2]Mannava S,Jinnah A H,Plate J F,et al.Basic shoulder arthroscopy:beach chair patient positioning[J].Arthrosc Tech,2016,5(4):731-735.
[3]Provencher C M T,McIntire E S,Gaston T M,et al.Avoiding complications in shoulder arthroscopy:pearls for lateral decubitus and beach chair positioning[J].Tech Shoulder Elbow Surgery,2010,11(1):1-3.
[4]Terry M A,Altchek D W.Diagnostic Shoulder Arthroscopy Technique:Beach Chair Position[M].Shoulder Arthroscopy.New York,NY,2003:9-15.
[5]Sulaiman L,Macfarlane R J,Waseem M.Current concepts in anaesthesia for shoulder surgery[J].Open Orthop J,2013,7:323-328.
[6]Morrison D S,Schaefer R K,Friedman R L.The relationship between subacromial space pressure,blood pressure,and visual clarity during arthroscopic subacromial decompression[J].Arthroscopy,1995,11(5):557-560.
[7]Gillespie R,Shishani Y,Streit J,et al.The safety of controlled hypotension for shoulder arthroscopy in the beachchair position[J].J Bone Joint Surg Am,2012,94(14):1284-1290.
[8]Kohn L T,Corrigan J M,Donaldson M S.To err is human:Building a safer health system[J].J Interprofessional Care,2002,16(4):413-416.
[9]Dove P,Gilmour F,Weightman W M,et al.Patient perceptions of regional anesthesia:Influence of gender,recent anesthesia experience,and perioperative concerns[J].Reg Anesth Pain Med,2011,36(4):332-335.
[10]Wu C L,Rouse L M,Chen J M,et al.Comparison of postoperative pain in patients receiving interscalene block or general anesthesia for shoulder surgery[J].Orthopedics,2002,25(1):45-48.
[11]Wilder B L.Hypothesis:the etiology of midcervical quadriplegia after operation with the patient in the sitting position[J].Neurosurgery,1982,11(4):530-531.
[12]Park T S,Kim Y S.Neuropraxia of the cutaneous nerve of the cervical plexus after shoulder arthroscopy[J].Arthroscopy,2005,21(5):631.
[13]Rains D D,Rooke G A,Wahl C J.Pathomechanisms and complications related to patient positioning and anesthesia during shoulder arthroscopy[J].Arthroscopy,2011,27(4):532-541.
[14]Rhee Y G,Cho N S.Isolated unilateral hypoglossal nerve palsy after shoulder surgery in beach-chair position[J].JShoulder Elbow Surg,2008,17(4):28-30.
[15]Holtzman A J,Glezos C D,Feit E J,et al.Prevalence and risk factors for lateral femoral cutaneous nerve palsy in the beach chair position[J].Arthroscopy,2017,33(11):1958-1962.
[16]Moen T C,Rudolph G H,Caswell K,et al.Complications of shoulder arthroscopy[J].J Am Acad Orthop Surg,2014,22(7):410-419.
[17]Jerosch J,Filler T J,Peuker E T.Which joint position puts the axillary nerve at lowest risk when performing arthroscopic capsular release in patients with adhesive capsulitis of the shoulder?[J].Knee Surg Sports Traumatol Arthrosc,2002,10(2):126-129.
[18]Boykin R E,Friedman D J,Zimmer Z R,et al.Suprascapular neuropathy in a shoulder referral practice[J].JShoulder Elbow Surg,2011,20(6):983-988.
[19]Paxton E S,Backus J,Keener J,et al.Shoulder arthroscopy:basic principles of positioning,anesthesia,and portal anatomy[J].J Am Acad Orthop Surg,2013,21(6):332-342.
[20]Jeong H,Lee S H,Jang E A,et al.Haemodynamics and cerebral oxygenation during arthroscopic shoulder surgery in beach chair position under general anaesthesia[J].Acta Anaesthesiol Scand,2012,56(7):872-879.
[21]Murphy G S,Szokol J W,Marymont J H,et al.Cerebral oxygen desaturation events assessed by near-infrared spectroscopy during shoulder arthroscopy in the beach chair and lateral decubitus positions[J].Anesth Analg,2010,111(2):496-505.
[22]Cox R M,Jamgochian G C,Nicholson K,et al.The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position:Arandomized blinded study[J].J Shoulder Elbow Surg,2018,27(4):692-700.
[23]Sia S.Hypotensive technique and sitting position in shoulder surgery[J].Anesth Analg,2003,97(4):1198.
[24]Fuchs G,Schwarz G,Kulier A,et al.The influence of positioning on spectroscopic measurements of brain oxygenation[J].J Neurosurg Anesthesiol,2000,12(2):75-80.
[25]Truijen J,Kim Y S,Krediet C T,et al.Orthostatic leg blood volume changes assessed by near-infrared spectroscopy[J].Exp Physiol,2012,97(3):353-361.
[26]Lee J H,Min K T,Chun Y M,et al.Effects of beach-chair position and induced hypotension on cerebral oxygen saturation in patients undergoing arthroscopic shoulder surgery[J].Arthroscopy,2011,27(7):889-894.
[27]Aguirre J A,Etzensperger F,Brada M,et al.The beach chair position for shoulder surgery in intravenous general anesthesia and controlled hypotension:Impact on cerebral oxygenation,cerebral blood flow and neurobehavioral outcome[J].J Clin Anesth,2019,53:40-48.
[28]Pohl A,Cullen D J.Cerebral ischemia during shoulder surgery in the upright position:A case series[J].J Clin Anesth,2005,17(6):463-469.
[29]Salazar D,Sears B W,Aghdasi B,et al.Cerebral desaturation events during shoulder arthroscopy in the beach chair position:Patient risk factors and neurocognitive effects[J].J Shoulder Elbow Surg,2013,22(9):1228-1235.
[30]Koh J L,Levin S D,Chehab E L,et al.Neer Award 2012:Cerebral oxygenation in the beach chair position:Aprospective study on the effect of general anesthesia compared with regional anesthesia and sedation[J].J Shoulder Elbow Surg,2013,22(10):1325-1331.
[31]Drummond J C,Lee R R,Howell J P Jr.Focal cerebral ischemia after surgery in the"beach chair"position:The role of a congenital variation of circle of Willis anatomy[J].Anesth Analg,2012,114(6):1301-1303.
[32]Salazar D,Hazel A,Tauchen A J,et al.Neurocognitive deficits and cerebral desaturation during shoulder arthroscopy with patient in beach-chair position:A review of the current literature[J].Am J Orthop,2016,45(3):63-68.
[33]Cox R M,Jamgochian G C,Nicholson K,et al.The effectiveness of cerebral oxygenation monitoring during arthroscopic shoulder surgery in the beach chair position:Arandomized blinded study[J].J Shoulder Elbow Surg,2018,27(4):692-700.
[34]Cardim D,Robba C,Matta B,et al.Cerebrovascular assessment of patients undergoing shoulder surgery in beach chair position using a multiparameter transcranial Doppler approach[J].J Clin Monit Comput,2018:1-11.
[35]Calvisi V,Lupparelli S,Rossetti S.Subcutaneous emphysema and pneumomediastinum following shoulder arthroscopy with brachial plexus block:A case report and review of the literature[J].Arch Orthop Trauma Surg,2009,129(3):349-352.
[36]Marrero L G,Nelman K R,Nottage W M.Long-term follow-up of arthroscopic rotator cuff repair[J].Arthroscopy,2011,27(7):885-888.
[37]Randelli P,Castagna A,Cabitza F,et al.Infectious and thromboembolic complications of arthroscopic shoulder surgery[J].J Shoulder Elbow Surg,2010,19(1):97-101.
[38]Dodson C C,Craig E V,Cordasco F A,et al.Propionibacterium acnes infection after shoulder arthroplasty:A diagnostic challenge[J].J Shoulder Elbow Surg,2010,19(2):303-307.
[39]Millett P J,Yen Y M,Price C S,et al.Propionibacterium acnes infection as an occult cause of postoperative shoulder pain:A case series[J].Clin Orthop Relat Res,2011,469(10):2824-2830.
[40]Jameson S S,James P,Howcroft D W,et al.Venous thromboembolic events are rare after shoulder surgery:Analysis of a national database[J].J Shoulder Elbow Surg,2011,20(5):764-770.
[41]Levy B J,Tauberg B M,Holtzman A J,et al.Reducing lateral femoral cutaneous nerve palsy in obese patients in the beach chair position:effect of a standardized positioning and padding protocol[J].J Am Acad Orthop Surg,2018:Oct 15.
[42]Mazzon D,Danelli G,Poole D,et al.Beach chair position,general anesthesia and deliberated hypotension during shoulder surgery:A dangerous combination![J].Minerva Anestesiol,2009,75(5):281-282.
[43]Stecco C,Gagliano G,Lancerotto L,et al.Surgical anatomy of the axillary nerve and its implication in the transdeltoid approaches to the shoulder[J].J Shoulder Elbow Surg,2010,19(8):1166-1174.
[44]Yoo J C,Kim J H,Ahn J H,et al.Arthroscopic perspective of the axillary nerve in relation to the glenoid and arm position:A cadaveric study[J].Arthroscopy,2007,23(12):1271-1277.
[45]Gabriel R A,Beverly A,Dutton R P,et al.Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia:A retrospective analysis of 23,073patients[J].JClin Monit Comput,2017,31(5):877-884.
[46]Woo J H,Kim Y J,Jeong J S,et al.Compression stockings reduce the incidence of hypotension but not that of cerebral desaturation events in the beach-chair position:A randomized controlled trial[J].Korean J Anesthesiol,2018,71(2):127-134.
[47]Isley M R,Edmonds H L,Stecker M,et al.Guidelines for intraoperative neuromonitoring using raw(analog or digital waveforms)and quantitative electroencephalography:Aposition statement by the American Society of Neurophysiological Monitoring[J].J Clin Monit Comput,2009,23(6):369-390.
[48]Papadonikolakis A,Wiesler E R,Olympio M A,et al.Avoiding catastrophic complications of stroke and death related to shoulder surgery in the sitting position[J].Arthroscopy,2008,24(4):481-482.
[49]Saltzman M D,Nuber G W,Gryzlo S M,et al.Efficacy of surgical preparation solutions in shoulder surgery[J].J Bone Joint Surg Am,2009,91(8):1949-1953.