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Korean Journal of Anesthesiology 2008;55(3):326-331.
DOI: https://doi.org/10.4097/kjae.2008.55.3.326   
Manipulation of frozen shoulder under monitored anesthesia care with propofol and remifentanil.
Choon Gun Ryu, Nam Su Gil, Yong Chul Kim, Sang Chul Lee, Young Jin Ro, Jong Su Kim, Sung Eun Sim
1Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
2Department of Anesthesiology and Pain Medicine, Boramae Municipal Hospital, Seoul, Korea. euny@hanafos.com
Manual manipulation under anesthesia in primary frozen shoulder is recommended for restoring range of motion and improving function. Usually, manipulation is performed briefly under general anesthesia, which accompanies some anesthesia- related risks for outpatients.
12 patients suffered from primary frozen shoulder were received manipulation under monitored anesthesia care (MAC) with propofol (1 mg/kg) and remifentanil (25microgram) as an initial dose. And then we injected additional bolus dose (propofol 20 mg, remifentanil 10microgram) in case of inadequate sedation. After manipulation, sodium hyaluronate 20 mg, 0.75% ropivacaine 22.5 mg and ketorolac 30 mg were injected into the glenohumeral joint. Clinical data were gathered at baseline and at 4 weeks after manipulation.
The procedure was carried out successfully under MAC. Clinical results including improvements of visual analogue scale of pain and range of motion were comparable to previous studies. 2 patients who received relatively large doses of anesthetics have required triple airway maneuver and manual mask ventilation for 1 to 2 minutes respectively because of desaturation below 90%. There are not any serious adverse effects.
MAC with propofol and remifentanil makes it possible to get adequate level of sedation for shoulder manipulation and to reduce recovery time from anesthesia at the same time. MAC, therefore, is the adequate outpatient anesthetic method for shoulder manipulation.
Key Words: frozen shoulder; manipulation under anesthesia; monitored anesthesia care


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