Codes Please The CRNA provided the anesthesia care without medical direction. The patient's physical status was -P2. LO

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Codes Please
The CRNA provided the anesthesia care without medical
direction. The patient's physical status was -P2.

LOCATION: Outpatient, Hospital
PATIENT: Denise Kohlmeir
PHYSICIAN: Mohomad Almaz, M.D.
ANESTHESIOLOGIST: Karen Demers, CRNA
PREOPERATIVE DIAGNOSIS: Loose body, right knee.
POSTOPERATIVE DIAGNOSIS: Same.
OPERATIVE PROCEDURE: Right knee arthroscopy with removal of
loose body.
POSITION: Supine.
ANESTHESIA: General.
INDICATIONS: The patient is a 26-year-old young lady who
underwent right knee arthroscopy with bone grafting of an
osteochondritis dissecans lesion in May. The patient had removal of
loose bodies and cancellous autograft placement into the base of
her osteochondritis dissecans lesion at that time.
Postoperatively, she has been doing extremely well, but recently
developed some catching and locking in her knee. A new MRI was
obtained which shows a loose body sitting in the suprapatellar
pouch. She presents electively today for right knee
arthroscopy.
DESCRIPTION OF PROCEDURE: The patient was brought to the
Operating Room and placed supine on the operating table. After
administration of general anesthesia and receiving Ancef
antibiotic, her right lower extremity was prepped and draped in the
normal sterile fashion with a tourniquet about her right proximal
thigh. The left lower extremity was draped over a well-leg holder,
well padded and secured.
The procedure began with exsanguination of
the right lower extremity and inflation of the thigh tourniquet to
250 mmHg. Three arthroscopic portals were made; the superolateral
portal was used for outflow and medial and lateral parapatellar
tendon portals were used for arthroscopic tool placement.
Evaluation of the patient's knee joint showed she had normal
articular cartilage on the medial and lateral facets of the
patella, the apex of the patella, and the femoral trochlea.
Evaluation of the femoral notch showed a normal anterior and
posterior cruciate ligament. Evaluation of the medial compartment
showed that the patient had excellent healing and shape to the
medial femoral condyle. There was slight bulging in the area of the
fibrocartilage, but there was no fraying or flapping on the
fibrocartilage and there was good fill with reasonable contour of
the medial femoral condyle. Evaluation of the lateral compartment
showed normal articular cartilage on the femur and tibia with a
normal lateral meniscus.
Attention was turned to the medial and
lateral gutter where the loose body was identified. It was directed
up into the suprapatellar pouch and was easily removed using an
arthroscopic grasper.
At this time, all arthroscopic tools were
removed. A drain was placed in the superolateral portal. The
portals were closed with 4-0 Vicryl and covered with Steri-Strips.
A sterile dressing was applied and held in place with a Kerlix. A
TED stocking was placed on the patient's leg and an ice pack
applied to the knee. The tourniquet was released.
The patient tolerated the procedure well
and was taken to the recovery room in stable condition.
Pathology Report Later Indicated: tissue from knee benign.