An interventional study of Intraoperative fluid management stratigies. in Shoulder Arthropathy Associated With Other Conditions, sponsored by Assiut University. Completed at 1 site in Egypt. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-09-16.
Sponsored by Assiut University · Not applicable, Interventional, and Diagnostic
The primary aim of our study is to leverage lung ultrasound to assess and identify postoperative pulmonary complications following shoulder arthroscopic surgery and the implications of the used irrigation fluid.the investigators will further investigate the impact of intraoperative fluid management strategies on these Postoperative pulmonary complications and their effects on hemodynamics. By harnessing the potential of lung ultrasound in this context, we aspire to enhance both the diagnostic capabilities and overall safety of shoulder arthroscopic surgery, ultimately improving patient outcomes.
Shoulder arthroscopy, a minimally invasive surgical technique, has become a preferred method for addressing conditions like rotator cuff tears and recurrent joint instability due to its advantages, such as reduced post-operative pain and quicker rehabilitation. However, recent attention has shifted to potential complications, including issues related to irrigation fluid, patient positioning in the beach-chair posture, and anesthesia protocols. One key concern is the use of pressurized irrigation fluid, which, while essential for visualization, carries the risk of complications, including subcutaneous emphysema, pneumomediastinum, tension pneumothorax, air embolism, pulmonary edema, and atelectasis. These complications can have systemic effects, emphasizing the need for precise intraoperative fluid management.
Intraoperative fluid management strategies are a subject of continuous debate in the field of surgery, giving rise to three main strategies: 'liberal,' 'restricted,' and 'goal-directed' fluid therapy. These strategies vary in terms of the type of fluid used, timing of administration, and volume administered. While administering large volumes of fluids may improve organ perfusion, it may also increase the incidence of perioperative cardiopulmonary complications. Conversely, fluid restriction may reduce the length of hospital stay but increase the risk of postoperative acute kidney injury. Goal-directed therapy, which tailors fluid administration based on reproducible endpoints, has been associated with improved perioperative outcomes. The Bezold-Jarisch reflex is a cardiovascular reflex that can result in severe bradycardia and vasodilation when activated, especially in fasting patients with beach-chair position and other positions that lead to pooling of the blood in the lower limb and, in turn, lead to a decrease in venous return.
Understanding the intricate relationship between this reflex and intraoperative fluid management is paramount for improving patient safety and surgical outcomes. This reflex can be triggered by various factors, including rapid fluid administration and alterations in venous return, particularly in patients positioned in the beach chair posture.
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Exclusion Criteria:
Medical Comorbidities:
The restrictive fluid group (RG) aims to achieve a net zero fluid balance and involves a 2 mL/kg bolus at anesthesia induction, followed by an intraoperative crystalloid infusion at a rate of 4 mL/kg/hr.
Other: Intraoperative fluid management stratigies.
The liberal group (LG) will receive a 10 mL/kg bolus at anesthesia induction, followed by an intraoperative crystalloid infusion at a rate of 8 mL/kg/hr \[12, 13\].
Other: Intraoperative fluid management stratigies.
Regimens of different intraoperative fluid management The restrictive fluid group (RG) aims to achieve a net zero fluid balance and involves a 2 mL/kg bolus at anesthesia induction, followed by an intraoperative crystalloid infusion at a rate of 4 mL/kg/hr. The other group of patients, the liberal group (LG), will receive a 10 ml/kg bolus at anesthesia induction,followed by an intraoperative crystalloid infusion at a rate of 8 ml/kg/hr.
lung ultrasound score (LUS)
we will Identify postoperative pulmonary complications using the lung ultrasound score (LUS) following shoulder arthroscopic surgery to assess the implications of the used irrigation fluid and The intraoperative Fluid infusion * 0 = normal lung aeration, * 1 = moderate loss of aeration * 2 = severe loss of aeration * 3 = complete loss of lung aeration
Time frame: 1-One hour before the start of Surgery. 2-Two hours after the End of surgery.
Blood Pressure
Measured in millimeters of Mercury (mm Hg).
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Heart Rate
Measured in Beats per Minute (bpm).
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Oxygen Saturation
Measured in Percentage (%).
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Vasopressor Used and Dose
Measured in milligrams (mg).
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Interval for Repeated Dose of the Vasopressor.
Measured in minutes.
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Duration of Action of used Vasopressor
Measured in Minutes.
Time frame: Continuous recording every 15 minutes from the start of the operation until its end, assessed up to the completion of the surgical procedure.
Plan to share: No
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Assiut University