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Can intubation for a shoulder surgery cause a stroke?

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General Surgeon
Practicing since : 2008
Answered : 5770 Questions
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I was scheduled for shoulder surgery for a detached tendon related to my rotator cuff. About two and one half years ago I had an internal left carotid dissection at the base of my skull with approximately 50 per cent lumen reduction. A follow up MRI revealed resolution of the problem with a slight irregularity in the contour of the artery within 6 months on Clopidogrel after diagnosis. Upon learning this, the Anesthesiologist refused to accompany the surgeon unless I get clearance from a Cardiologist. At the time of the incident I was residing in NJ and have since moved to Arizona. While in NJ, the primary physician managing my treatment was a neurologist. The only reason I had a Cardiologist was due to my family history of cardiovascular disease. My Mother had an abdominal aortic aneurism and my Father had a massive stroke which is my greatest fear. The Anesthesiologist is very concerned about the possibility of me having a stroke as a result of the intubation. I was a Respiratory Therapist for 15 years and have intubated patients many times. My family Cardiologist in NJ was not involved at all and my personal opinion is that the NJ Neurologist whose care I was under would be the best person to advise. I have no Cardiac problems at all except for genetically high cholesterol which has been well controlled for over 7 years. I have an MRI scheduled for the right shoulder to see if I may have a similar problem there as well. Surgery was to be performed on the left shoulder since I am experiencing similar symptoms on the right as well. I also owned a health club for 15 years as well and exercise is a big part of my life. I am now retired. I thought that 6 weeks in a sling followed by 10 weeks of physical therapy was stressing me out, but the thought of possibly having a stroke makes rehab trivial after seeing my father living paralyzed and speechless for 9 years. Regardless of whom I may or may not get approval for this surgery, to say I'm very concerned about this situation is a massive understatement. I've been wondering about nasal intubation, which should be much less traumatic or the possibility of not undergoing general anesthesia and having a local nerve block instead. I am 66 years old and in good health otherwise. Pain is very minor, but the surgeon feels that makes this this the best time to do it and that it will inevitably get worse in time. Any and all advice you may give me will be greatly appreciated !!! Joe.
Mon, 4 Jun 2018 in Lump
 
 
Answered by Dr. Grzegorz Stanko 8 hours later
Brief Answer:
Intubation can be done gently.

Detailed Answer:
Hello.

Thank you fir the query.

Intubation intself is not a risk factor of stroke. The tube is soft and does not compress any artery and for sure not cervical arthery. So nasal or throat intubation does not change anything.
Stroke usually is caused by heart arrhythmia. Narrow cervical artery can be the source of blood clot as well.
The only way intubation can increase the risk of it, is when someone during the intubation compresses the artery (sometimes they perform a Sellick manevour to close the esophagus during this procedure). And this applies to healthy cervical arteries as well.
Once we know it, it is possible to perform it gently with a bronchoscope and the stroke should not be the problem.
Local anesthesia is a good idea, especially brachial plexus anesthesia, however it may be a little to low for this surgery. But it seems possible.

Hope this helps. Feel free to ask if I have missed any information.
Regards.
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