Cardiovascular Effects of Adding Adrenaline to Arthroscopic Knee Irrigation Fluid in Canine Diagnostic Procedures

TL;DR

This study finds that adding adrenaline to knee irrigation fluid in dogs does not significantly affect heart function or improve visibility during arthroscopy.

Contribution

The study evaluates the safety of adrenaline in canine arthroscopy irrigation fluid and finds no significant cardiovascular effects.

Findings

Adrenaline at 0.33 mg L−1 in irrigation fluid does not cause significant cardiovascular changes in dogs.

Advanced hemodynamic monitoring showed consistent results with no alterations in parameters.

No significant improvement in image quality was observed with adrenaline use.

Abstract

Intra-articular bleeding resulting from the creation of the arthroscopic portal and manipulation of joint tissues can significantly impair visual clarity during the procedure. In human medicine, adrenaline is commonly added to the irrigation fluid to enhance visibility. However, this practice carries a minimal risk of inducing hypertension and/or tachycardia (with or without arrhythmias). This study aims to assess whether the use of adrenaline at a concentration of 0.33 mg L−1 in the arthroscopic irrigation fluid would cause hemodynamic alterations in dogs. In half of the dogs, advanced hemodynamic parameters were monitored using the pressure recording analytical method (PRAM) with the MostCare® system. No significant differences were observed in cardiovascular parameters between groups at different time points or within the same group over time. In conclusion, the use of adrenaline at 0.33 mg L−1 as a haemostatic agent in arthroscopic irrigation fluid does not produce significant cardiovascular alterations in dogs. Similarly, advanced monitoring appears to show consistent results, with no alterations in hemodynamic parameters.

Background: Adrenaline is used as a local haemostatic in human arthroscopy, due to its peripheral vasoconstrictive properties, which enhance image quality with minimal cardiovascular side effects. This study aims to evaluate the effects of adrenaline in arthroscopic irrigation fluid and asses its impact on image visibility. Methods: A prospective, double-blind, randomised clinical trial was conducted on 20 knees from 18 dogs undergoing diagnostic arthroscopies. Dogs were randomly assigned to two groups: group A (received lactate Ringer (LR) with adrenaline 0.33 mg L−1) and group C (received LR with 0.33 mL of saline solution). Cardiovascular parameters were recorded using a multiparametric monitor, with advanced hemodynamic parameters assessed using the PRAM method (MostCare®) in half of the dogs, and glucose, cortisol, and adrenaline levels were measured at various time points. Hemoglobin concentration was calculated based on the residual fluid and image quality was evaluated by a blinded surgeon using a visual analog scale (VAS). Results: No significant differences between groups in cardiovascular parameters, glucose, cortisol, adrenaline, hemoglobin, or VAS scores; only time differences for cortisol and adrenaline. Conclusions: The use of adrenaline at 0.33 mg L−1 in arthroscopic irrigation fluid does not cause significant cardiovascular changes or improve image quality, confirming it is safe at this concentration.

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