| Abstract [eng] |
Background. Medical progress enables more shoulder arthroscopies in day surgery under general and/or regional anaesthesia. Airway management involves a laryngeal mask airway or endotracheal intubation. While anaesthesia methods in the beach chair position are widely discussed, airway management remains under-researched. The aim of the study. Retrospectively compare the effect of the general anaesthesia method combined with brachial plexus block for perioperative outcomes during shoulder arthroscopy in a beach chair position. Research objectives. 1. Identify the frequency of complications in the perioperative shoulder arthroscopy period associated with airway management type (laryngeal mask/endotracheal intubation); 2. Evaluate the need for sedation, analgesia, relaxation and infusion; 3. Evaluate the influence of anaesthesia on patient safety when using controlled hypotension in this type of surgery; 4. Suggest criteria for anaesthesia choice during shoulder arthroscopy depending on the patient's physical condition and comorbidities. Study methods. With permission from the Ethical Committee of the Republican Vilnius University Hospital to use anonymised, summarised patient data from shoulder arthroscopies in 2020, a retrospective study was conducted in 2021−2023. Demographic data, anaesthesia type, medication groups and their duration of action, anaesthetic dosages, the need for vasoactive medication, vital signs monitoring and changes during and post-surgery, adverse reactions during surgery, infusion, postoperative analgesia and hospitalisation time were collected and analysed. A statistically significant difference was considered when p < 0.05. Results. The study included ninety-two patients. With brachial plexus block, 53.26% received laryngeal mask airway management and 46.74% − endotracheal intubation. Prolonged anaesthesia lowered mean arterial pressure for laryngeal anaesthesia patients (r = −0.525, p < 0.001). Although hypertensive patients showed greater mean arterial pressure deviation (LMA r = 0.399, p = 0.005 vs ETA r = 0.356, p = 0.019), endotracheal anaesthesia provided more hemodynamic stability regardless of age or medication. Higher fentanyl doses were used in laryngeal mask anaesthesia induction (0.157 mg vs 0.127 mg, p = 0.001), and almost half of this group of patients needed antiemetics (40.82% vs 6.98%, p < 0.001). Vasoactive medication use was similar between groups. Most laryngeal mask anaesthesia patients were transferred directly to the ward and required more postoperative analgesia. No early complications were observed – all patients were discharged the next day. Conclusions. Laryngeal mask anaesthesia benefits surgeries lasting up to an hour and patients with fewer comorbidities. However, endotracheal intubation favours cardiovascular pathology patients because it ensures better hemodynamic stability regardless of age and medications and better analgesia and nausea control. |
