The Impact of Anesthesia on Glycine Absorption in Operative Hysteroscopy

Bergeron, Marie-Ève; Ouellet, Paul; Bujold, Emmanuel; Côté, Maxime; Rhéaume, Caroline; Lapointe, Daniel; Beaudet, Christine; Lemyre, Madeleine; Laberge, Philippe Y.

doi:10.1213/ane.0b013e31822649d4

Cited by 24 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the current case, the patient was under general anesthesia, which delayed the diagnosis. Regional anesthesia may be safer and beneficial to detect the early warning symptoms of this syndrome, since patients are awake (8). General anesthesia with endotracheal intubation could be safer in longer surgeries in which the risks of developing OHIA are high.…”

Section: Discussionmentioning

confidence: 99%

Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report

Santos

Coelho

2019

Anesth Pain Med

View full text Add to dashboard Cite

Introduction Operative hysteroscopy intravascular absorption (OHIA) syndrome is caused by intravascular absorption of fluid distension/irrigation medium during hysteroscopy. There are very few reported cases of this syndrome using saline as irrigation fluid. The current report was on a case of severe OHIA syndrome that necessitated resuscitation in an intensive care unit (ICU). Case Presentation A 41-year-old, 65-kg, smoker female patient was admitted for an endoscopic resection of submucous uterine myoma under general anesthesia using a laryngeal mask airway. In the 50th minute of the procedure, end-tidal CO 2 dropped from 35 to 25 mmHg and pulse oximetry (SpO 2 ) from 100% to 90%. Crackling sounds were heard from the base of the lungs. As a pulmonary oedema was suspected, the volume of irrigated saline was checked. A total of 4000 of the total 9000 mL of the saline had been absorbed into intravascular compartment. She developed a severe metabolic acidosis (pH 7.09) with severe hypokalemia (K + 2.3 mEq/L), hypocalcaemia (Ca 2+ 0.76 mEq/L), anemia (hemoglobin 5.3 g/dL), and hypothermia (tympanic temperature 33°C), as well as a generalized oedema with pulmonary and airway oedema. Due to airway oedema, she could only be intubated with a 6.5-mm tracheal tube. Resuscitation in the ICU was required. Electrolyte disturbances were corrected and furosemide was administered. She had a full recovery after 24 hours and 48 hours later, she was discharged. Conclusions Absorption of the irrigation fluid can result in life-threatening fluid overload. Accurate fluid balancing and limiting the operation time may prevent such complications. Therefore, early diagnosis and treatment of this syndrome is emphasized.

show abstract

Section: Discussionmentioning

confidence: 99%

Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report

Santos

Coelho

2019

Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…This is warranted because a high degree of hemodilution can cause greater coagulation impairment. It has previously been shown that during TURP, irrigation fluid is absorbed at a rate of 10 to 30 ml/min, and the average volume absorbed is 400–700 ml during hysteroscopic transcervical resection of the endometrium (TCRE) [8,21,22]. In the present study, although hypocoagulable change was observed in the 20% hemodilution group, each value of ROTEM parameter was within the normal reference range.…”

Section: Discussionsupporting

confidence: 37%

The effect of a mixture of 2.7% sorbitol-0.54% mannitol solution on blood coagulation: an invitro, observational healthyvolunteer study using rotational thromboelastometry (ROTEM)

Shin

Lee

2019

Korean J Anesthesiol

View full text Add to dashboard Cite

Background We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM). Methods Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol. Results Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample. Conclusions Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.

show abstract

“…In a RCT [63] comparing type of anaesthesia, women who underwent operative hysteroscopic procedures (endometrial resection with or without polypectomy or myomectomy) under general anaesthesia had a higher median glycine absorption compared to women who underwent these procedures using local paracervical anaesthesia with 1 % lidocaine and midazolam, sufentanil and propofol sedation (480 mL [76–1300 mL] versus 253 mL [70–728 mL], p = 0.01). General anaesthesia was also associated with a higher rate of glycine absorption >1000 mL (20 % versus 4 %), a greater fall in serum sodium concentration (2.0 meq/L versus 0.5 meq/L and a greater rate of fall in sodium concentration ≥10 meq/L (8 % versus 0 %) than local anaesthesia with sedation.…”

Section: Anaesthesia and Impact Upon Fluid Overload And Electrolyte Imentioning

confidence: 99%

BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy

et al. 2016

View full text Add to dashboard Cite

The Impact of Anesthesia on Glycine Absorption in Operative Hysteroscopy

Abstract: Compared with general anesthesia, local anesthesia with sedation is associated with less glycine absorption and should be considered the preferred method of anesthesia for operative hysteroscopy.

Cited by 24 publications

References 17 publications

Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report

Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report

The effect of a mixture of 2.7% sorbitol-0.54% mannitol solution on blood coagulation: an invitro, observational healthyvolunteer study using rotational thromboelastometry (ROTEM)

BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy

Contact Info

Product

Resources

About