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Deep sedation for arthroscopic knee surgery
136
ABSTRACTS
often found with a torn meniscus or anterior cruciate ligament accelerated the deterioration in polydioxanone sutures. Meniscal repair requires a suture that stabilizes the cartilage tissue until adequate healing occurs. These absorbable sutures were not capable of providing any significant support beyond the 6 weeks of immobilization commonly used for meniscus repair. Role of Arthroscopy in the Management of Pyarthrosis. J. Serge Parisien and Benjamin Shaffer. New York, New York, U.S.A. Acute septic arthritis, when not treated properly, can be a cause of destructive disorder of synovial joints. The classic management of pyarthrosis has been for many years either intermittent needle aspiration or drainage by arthrotomy, associated with the administration of appropriate antimicrobial therapy. Because needle aspiration cannot achieve adequate drainage of the joint and because arthrotomy may be associated with significant morbidity, arthroscopy has been advocated recently by a few authors in the management of joint infection. This study reports our experience with the use of this technique in the treatment of 16 patients (13 knees, two shoulders, and one ankle) with joint infection treated between 1976-1986. Age range was between 20 and 60 years. All patients were treated by arthroscopic debridement of necrotic synovium, fibrinous materials, and loculated pockets of adhesions, followed by the insertion of drains for continuous saline irrigation for 48 h. Appropriate antibiotics were given intravenously, followed by oral administration. Continuous passive motion with active range-of-motion exercises was an important part of the treatment protocol. Also, the patients were kept non-weightbearing for 6 weeks. The results were satisfactory in all patients with follow-up ranging from 6 months to 3 years.
Deep Sedation for Arthroscopic Knee Surgery. P. P. Casteleyn, M. A. Claeys, and F. Handelberg. Brussels, Belgium. General anesthesia is not always problem-free in outpatient cases. Prolonged recovery time, respiratory depression, vomiting, and the risk of aspiration pneumonitis are troublesome, if not frequent, complications. Local anesthesia, with the infiltration of multiple portals, the difficulties of joint maArthroscopy, Vol. 4, No. 2, 1988
nipulation, and the absence of tourniquet inflation, can be cumbersome. A third alternative was investigated in a prospective, consecutive series of 46 patients (mean age, 31.06; range: 16-68): deep sedation with a propofol (Diprivan) infusion of 9 mg/kg/h [Propofol has been showed previously to maintain unconsciousness, with dose-related sedative and amnestic proprieties in diagnostic procedures such as gastrointestinal endoscopies]. Propofol was combined in a doubleblind, randomized fashion with an analgesic drug, meptazinol in one 100 mg/2 ml i.v. administration, or with 2 ml of saline. Hemodynamic and respiratory parameters as well as depth of sedation and recovery time where monitored. The whole spectrum of arthroscopic and arthroscopic-assisted surgery was encountered (20 meniscectomies, one meniscal suture, six chondral shavings, two loose bodies, two plicae resections, one synovectomy, one anterior cruciate ligament suture, one medial retinaculum suture, three reductions with percutaneous osteosynthesis of tibial condyles). All procedures could be completely performed with tourniquet inflation using this type of sedation. Transient restlessness was observed in some patients on tourniquet inflation and skin incision. This could be managed by adapting the propofol administration. Meptazinol reduced significantly the incidence of movements and the total administered dose of propofol. Recovery time was short, with all hemodynamic and respiratory parameters within baseline values 10 min after the end of surgery. Full recovery of consciousness, without any malaise, nausea, or vomiting was obtained <30 min after surgery. The infusion of propofol with or without meptazinol gives a deep sedation that allows any type of arthroscopic surgery to be performed and provides a short and uncomplicated recovery. It could be considered superior to local anesthesia for operative ease and the range of possible procedures, and could offer lower risk and a faster recovery than general anesthesia.
Arthroscopic Anatomy of the Subacromial Space. Paul D. Fadale and Leslie S. Matthews. Baltimore, Maryland, U.S.A. One of the most significant advances in arthroscopic surgery of the shoulder has been in the evaluation of the subacromial space and decompression thereof for impingement syndromes. Arthroscopic
ABSTRACTS
often found with a torn meniscus or anterior cruciate ligament accelerated the deterioration in polydioxanone sutures. Meniscal repair requires a suture that stabilizes the cartilage tissue until adequate healing occurs. These absorbable sutures were not capable of providing any significant support beyond the 6 weeks of immobilization commonly used for meniscus repair. Role of Arthroscopy in the Management of Pyarthrosis. J. Serge Parisien and Benjamin Shaffer. New York, New York, U.S.A. Acute septic arthritis, when not treated properly, can be a cause of destructive disorder of synovial joints. The classic management of pyarthrosis has been for many years either intermittent needle aspiration or drainage by arthrotomy, associated with the administration of appropriate antimicrobial therapy. Because needle aspiration cannot achieve adequate drainage of the joint and because arthrotomy may be associated with significant morbidity, arthroscopy has been advocated recently by a few authors in the management of joint infection. This study reports our experience with the use of this technique in the treatment of 16 patients (13 knees, two shoulders, and one ankle) with joint infection treated between 1976-1986. Age range was between 20 and 60 years. All patients were treated by arthroscopic debridement of necrotic synovium, fibrinous materials, and loculated pockets of adhesions, followed by the insertion of drains for continuous saline irrigation for 48 h. Appropriate antibiotics were given intravenously, followed by oral administration. Continuous passive motion with active range-of-motion exercises was an important part of the treatment protocol. Also, the patients were kept non-weightbearing for 6 weeks. The results were satisfactory in all patients with follow-up ranging from 6 months to 3 years.
Deep Sedation for Arthroscopic Knee Surgery. P. P. Casteleyn, M. A. Claeys, and F. Handelberg. Brussels, Belgium. General anesthesia is not always problem-free in outpatient cases. Prolonged recovery time, respiratory depression, vomiting, and the risk of aspiration pneumonitis are troublesome, if not frequent, complications. Local anesthesia, with the infiltration of multiple portals, the difficulties of joint maArthroscopy, Vol. 4, No. 2, 1988
nipulation, and the absence of tourniquet inflation, can be cumbersome. A third alternative was investigated in a prospective, consecutive series of 46 patients (mean age, 31.06; range: 16-68): deep sedation with a propofol (Diprivan) infusion of 9 mg/kg/h [Propofol has been showed previously to maintain unconsciousness, with dose-related sedative and amnestic proprieties in diagnostic procedures such as gastrointestinal endoscopies]. Propofol was combined in a doubleblind, randomized fashion with an analgesic drug, meptazinol in one 100 mg/2 ml i.v. administration, or with 2 ml of saline. Hemodynamic and respiratory parameters as well as depth of sedation and recovery time where monitored. The whole spectrum of arthroscopic and arthroscopic-assisted surgery was encountered (20 meniscectomies, one meniscal suture, six chondral shavings, two loose bodies, two plicae resections, one synovectomy, one anterior cruciate ligament suture, one medial retinaculum suture, three reductions with percutaneous osteosynthesis of tibial condyles). All procedures could be completely performed with tourniquet inflation using this type of sedation. Transient restlessness was observed in some patients on tourniquet inflation and skin incision. This could be managed by adapting the propofol administration. Meptazinol reduced significantly the incidence of movements and the total administered dose of propofol. Recovery time was short, with all hemodynamic and respiratory parameters within baseline values 10 min after the end of surgery. Full recovery of consciousness, without any malaise, nausea, or vomiting was obtained <30 min after surgery. The infusion of propofol with or without meptazinol gives a deep sedation that allows any type of arthroscopic surgery to be performed and provides a short and uncomplicated recovery. It could be considered superior to local anesthesia for operative ease and the range of possible procedures, and could offer lower risk and a faster recovery than general anesthesia.
Arthroscopic Anatomy of the Subacromial Space. Paul D. Fadale and Leslie S. Matthews. Baltimore, Maryland, U.S.A. One of the most significant advances in arthroscopic surgery of the shoulder has been in the evaluation of the subacromial space and decompression thereof for impingement syndromes. Arthroscopic