Effects of positive end-expiratory pressure on arthroscopic shoulder surgery under general anesthesia

Abstract

Objective: Our study is a prospective, randomized study on patients undergoing arthroscopic shoulder surgery in the beach-chair position to evaluate the effects of positive end-expiratory pressure (PEEP) on hemodynamic stability, providing a bloodless surgical field and surgical satisfaction.
Methods: Fifty patients were divided into two groups. Group I (n=25) had zero end-expiratory pressure (ZEEP) administered under general anesthesia, and group II (n=25) had +5 PEEP administered. During surgery, intraarticular hemorrhage and surgical satisfaction were evaluated on a scale of 0–10. During surgery, at the 5th, 30th, 60th, and 90th minutes and at the end of surgery, heart rate, mean arterial pressure (MAP), and positive inspiratory pressure were recorded. At the end of the surgery, the amount of bleeding and duration of the operation were recorded.
Results: In group I, the duration of operation and amount of bleeding were found to be significantly greater than those in group II (p<0.05). The surgical satisfaction score and clarity of the surgical field were found to be significantly lower in group I than in group II (p<0.05). MAP values in group I were significantly lower than those in group II. The SPO₂ values in group I were significantly lower than those in group II.
Conclusion: Adding PEEP to the ventilation parameters of arthroscopic shoulder surgery in the beach-chair position reduces the amount of hemorrhage in the surgical field and thus increases surgical satisfaction without requiring the creation of controlled hypotension.

Keywords

• Anesthesia; arthroscopy; PEEP; positive end-expiratory pressure; shoulder.