The Predictor of Respiratory Discomfort After the Shoulder Arthroscopic Surgery

Study Overview
=================
Brief Summary
-----------------
The investigators applied upper airway ultrasonographic examination focusing the measurement of upper airway diameters in patients undergoing shoulder arthroscopic surgery to evaluate the change of upper airway anatomy before and after the surgery. The investigators also tried to find any findings of ultrasonographic examination that could reliably predict the dyspnea or airway compression after extubation. The investigators tried to compare the ultrasonographic findings with those of chest radiograph to validate the measurements of the ultrasonographic examination. A cuff leak test was preformed to evaluate its ability to predict the upper airway obstruction in shoulder arthroscopic surgery.

Detailed Description
-----------------
During shoulder arthroscopic surgery, extravasation of irrigation fluid can occur around the shoulder and trachea, compressing the upper airway. Although the extravasation is generally reabsorbed asymptomatically within 12 hours, there are cases that lead to reintubation or life-threatening complications. An endotracheal tube is the most reliable method of securing the airway from airway obstruction during a shoulder arthroscopy surgery. However, since the airway may become obstructed after extubation, airway patency should be verified before extubation. Direct visualization of the larynx or trachea using laryngoscopy or bronchoscopy is difficult due to the presence of the tracheal tube. A cuff leak around the tracheal tube in a cuff-deflated condition is suggested to be a predictor of successful extubation. However, its reliability has been questioned in adult patients. A cuff leak could be affected by paratracheal pressure, which is thought to be elevated during shoulder arthroscopy. In a recent study, it was shown that laryngeal ultrasound can be a reliable, non-invasive method for the evaluation of laryngeal morphology or predicting post-extubation stridor. The investigators applied upper airway ultrasonographic examination focusing the measurement of upper airway diameters in patients undergoing shoulder arthroscopic surgery to evaluate the change of upper airway anatomy before and after the surgery. The investigators also tried to find any findings of ultrasonographic examination that could reliably predict the dyspnea or airway compression after extubation. The investigators tried to compare the ultrasonographic findings with those of chest radiograph to validate the measurements of the ultrasonographic examination. A cuff leak test was preformed to evaluate its ability to predict the upper airway obstruction in shoulder arthroscopic surgery.

Official Title
-----------------
The Predictor of Respiratory Discomfort After the Shoulder Arthroscopic Surgery as Measured by Upper Airway Ultrasonography

Conditions
-----------------
Shoulder Arthroscopic Surgery

Intervention / Treatment
-----------------
* Other: upper airway ultrasonographic examination


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: patients undergoing elective shoulder arthroscopic surgery (rotator cuff repair) Exclusion Criteria: patients with airway anomaly patients with anticipated difficult airway patients with hemodynamic unstability patients with severe cardiopulmonary disease

Ages Eligible for Study
-----------------
Minimum Age: 20 Years
Maximum Age: 70 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| shoulder arthroscopic surgery group<br>the patients who undergo the elective shoulder arthroscopic surgery of rotator cuff repair | Other: upper airway ultrasonographic examination<br>* upper airway ultrasonographic examination and cuff leak test<br>* Other names: cuff leak test;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Airway transverse diameter | airway transverses diameter measured on the upper airway ultrasonographic image: measure at three level (vocal cord, subglottis, trachea) | 10 min before anesthesia induction | 
| Airway transverse diameter | airway transverses diameter measured on the upper airway ultrasonographic image: measure at three level (vocal cord, subglottis, trachea) | 20 min after end of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| depth of skin to airway anterior border | depth of skin to airway anterior border measured at three levels: vocal cord, subglottis, trachea level | 10 min before anesthesia induction and 20 min after the surgery | 
| depth of skin to pleura | bilateral depth of skin to pleura at first and third intercostal space on the midclavicualr line measuread on the ultrasonographic image | 10 min before anesthesia induction and 20 min after the end of surgery | 
| endotracheal tube balloon cuff pressure | endotracheal tube balloon cuff pressure | 10 min after anesthesia induction and 60 min after surgery start | 
| percent cuff leak | The difference in the actual exhaled volume between the averages of pre- and post-cuff deflation was calculated. This number was divided by the tidal volume before cuff deflation and multiplied by 100. The resulting number was recorded as the percent cuff leak. | 10 min after anesthesia induction and 60 min after surgery start | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
dyspnea, shoulder arthroscopic surgery, airway diameter