Houston Methodist. Leading Medicine

Shoulder FAQ


Have you ever heard of a surgeon using laughing gas during arthroscopic surgery? Not for the patient but for the joint? What's the advantage of that technique?


When performing arthroscopic surgery on the joint, it is necessary for the surgeon to put something inside the joint to distend or expand it. Over the years, different substances have been used. Nitrous oxide (laughing gas) was first used way back in the 1920s. The practice was continued throughout much of the 20th century (1900s). But it was discovered that air embolism from this technique could cause sudden death. Embolism is another word for an object (e.g., air, blood, fat) that travels through the bloodstream, lodges in a blood vessel, and blocks it. Surgeons abandoned the use of nitrous oxide and used carbon dioxide instead. But studies showed that the use of any gas could result in a deadly embolism. Now surgeons use water or saline (salt solution). But guess what? Cases of sudden death have occurred even when using an all-liquid arthroscopic system. It's rare but it's still fatal and therefore unacceptable. Surgeons won't have to abandon the use of saline. But a recent experiment showed that careful pre-op and intraoperative handling of the bags of saline-solution is needed to bleed the bags of any air and prime the tubing that connects the bags to the pump. It is suspected that venous air embolism during shoulder arthroscopy happens more often than is realized or reported. This simple change in procedure can be done with a sterile technique. And best of all, it's 100 per cent effective. Luke Austin, MD, et al. Commercial Liquid Bags as a Potential Source of Venous Air Embolism in Shoulder Arthroscopy. In The Journal of Bone and Joint Surgery. September 1, 2010. Vol. 92-A. No. 11. Pp. 2110-2114.

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