Abstract
Purpose
To determine if systemic absorption of sorbitol 2.5%/mannitol 0.54% imgation solution (165 mosm·L−1) during hysteroscopic endometrial ablation with diathermy is associated with hyponatraemia and hypoosmolality.
Methods
In 35 day surgery patients in a university hospital we measured baseline preoperative variables: serum sodium and creatinine concentrations and osmolality, haematocnt, haemoglobin, urine osmolality and sodium concentration, and weight. Fractional excretion of sodium (FENa) was calculated. The same observations were obtained postoperatively before discharge (one hour post resection). Volumes of intraoperative fluid imgation intravasation and penoperative intravenous fluid absorption (lactated Ringer’s solution) were estimated clinically (vdumetric).
Results
The mean (± SD) serum sodium concentration preoperatively was 140.3 ± 2.4 mmol·L−1: and postoperatively, 139.7 ± 2.2 mmol·L−1 (P = NS). The serum osmdality decreased from 285.4 ± 4.5 to 282.6 ± 4.1 mmol·kg (P < 0.00l). The mean volume of intravasated irrigation fluid was 26.4 ml (range 0–300). During the same time, the FENa increased from 0.57% to 0.79% (P < 0.001).
Conclusion
In these patients, closely and continuously observed for imbalance between infused and collected irrigation fluid, there was no clinical evidence for hyponatraemic hypoosmolality. However, there was a small 1% ± 1.5% (mean ± SD: range −3.4 to 3.6%) decrease in plasma osmolality despite adequate blood volumes as shown by urinary sodium indices.
Résumé
Objectif
Déterminer si I’absorption systémique d’une solution d’irrigation de sorbitol 2,5% avec mannitol 0,54% (164 mosm·L−1) pendant I’ablation endoscopique de I’endomètre par diathermie est associée à de I’hyponatrémie et à de I’hypoosmolalité.
Methodes
Sur une pénode de trente-cinq jours, nous avons mesuré dans un hôpital universitaire les variables préopératoires de base de la natrémie et de la créatininémie, et I’osmolalité, I’hématocrite, I’hémoglobine, I’osmolalité et la concentration du sodium urinaires ainsi que le poids. L’excrétion fractionnée du sodium (FENa) a été calculée. Les mêmes vanables ont été notées après l’intervention au moment du congé (accordé une heure après la résection). Le vdume de I’absorption vasculaire peropératoire du liquide d’irrigation et le volume de liquide intraveineux administré pendant la période périopératoire (solution de lactate de Ringer) ont été évalués par volumétrie.
Résultats
La natrémie moyenne (±ET) préopératoire était 140,3 ± 2,4 mosm·L−1. et postopératoire de 138 ± 2.2 mosm·L−1 (P = NS). L’osmolalite sérique a diminué de 285,4 ± 4,5 à 282,6 ± 4,1 mosm·L−1 (P < 0,001). Le volume moyen du liquide d’irrigation absorbé était de 26,4 ml (écart de 0 à 300). Pendant la même pénode. la FENa augmentait de 0,57% à 0,79% (P < 0,01)
Conclusion
Chez ces patientes qui sont sous surveillance continuelle pour un déséquilibre entre le liquide perfusé et collecté, I’hypoosmolalité hyponatrémique n’a pas été cliniquement démontrée. Cependant, on a noté une petite diminution de 1% ± 1,5% (moyenne ± ET; écart de 3,4 à 3,6%) de l’osmolalité plasmatique malgré une volumie adéquate comme l’ont démontré les indices du sodium unnaire.
Article PDF
Similar content being viewed by others
References
Carlson KJ, Nichols DH, Schiff I. Indications for hysterectomy. N Engl J Med 1993; 328: 856–60.
Arieff Al, Ayus JC. Endometrial ablation complicated by fatal hyponatremic encephalopathy. JAMA 1993; 270: 1230–2.
Lyon RP, Mangar D, O’Connor TM, et al. Hyponatremic encephalopathy after endometrial ablation (Letters). JAMA 1994; 271: 343–5.
D’Agosto J, Ali NMK, Maier D. Absorption of irrigating solution during hysteroscopic metroplasty Anesthesiology 1990; 72: 379–80.
Creevy CD. The importance of hemolysis during transurethral prostatic resection; a clinical investigation. J Urol 1948; 59: 1217–32.
Witz CA, Schenken RS, Silverberg KM, Olive DL, Burns WN. Complications associated with the absorption of hysteroscopic fluid media. Fertil Steril 1993; 60: 745–56.
Vercellini P, Rossi R, Pagnoni B, Fedele L. Hypervolemic pulmonary edema and severe coagulopathy after intrauterine dextran instillation. Obstet Gynecol 1992; 79: 838–9.
Eugster D. Cardiac arrest during endometrial ablation (Letter). Anaesth Intensive Care 1993; 2: 891–2.
Vacanti CA, Lodhia KL. Fatal massive air embolism during transurethral resection of the prostate. Anesthesiology 1991; 74: 186–7.
Tur Kaspa I. Hyperbaric oxygen therapy for air embolism complicating operative hysteroscopy (Letter). Am J Obstet Gynecol 1990; 163: 680–1.
Hulka JF, Peterson HB, Phillips JM, Surrey MW. Operative hysteroscopy. American Association of Gynecologic Laparoscopists 1991 Membership Survey. Reprod Med 1993; 38: 572–3.
O’Connor H, Magos A. Endometrial resection for the treatment of menorrhagia. N Engl J Med 1996: 335: 151–6.
Davidman M. The management of hypo-osmolar states. Annals RCPSC 1994: 27: 90–2.
Glantz SA. Primer of Biostatistics, 3rd ed. New York: McGraw-Hill, 1992: 174.
Hurlbert BJ, Wingard DW. Water intoxication after 15 minutes of transurethral resection of the prostate. Anesthesiology 1979; 50: 355–6.
Shepard RL, Kraus SE, Babayan RK, Siroky MB. The role of ammonia toxicity in the post transurethral prostatectomy syndrome. Br J Urol 1987; 60: 349–51.
Dimberg M, Allgen L-G, Norlen H. Absence of lactate accumulation on transurethral resection of the prostate using 2.5% sorbitol solution as an irrigating fluid. Scand J UrolNephrol 1988; 22: 119–24.
Stalberg HP, Hahn RG, Jones AW. Ethanol monitoring of transurethral prostatic resection during inhaled anesthesia. Anesth Analg 1992; 75: 983–8.
Williamson KM, Mushambi MC. Complications of hysteroscopic treatments of menorrhagia (Editorial). Br J Anaesth 1996: 77: 305–7.
Dimberg M, Norlen H, Allgen L-G, Allgen T, Wallin M. A comparison between two hypotonic irrigating solutions used in transurethral resections of the prostate: sorbitol (2%)-mannitol (1%) and 1.5% glycine solutions. Scand J Urol Nephrol 1992; 26: 241–7.
Chui FT, Short TG, Leung AKL, Tan PE, Oh TE. Systemic absorption of glycine irrigation solution during endometrial ablation by transcervical endometrial resection. Med J Aust 1992; 157: 667–9.
McSwiney M, Myatt J, Hargreaves M. Transcervical endometrial resection syndrome. Anaesthesia 1995; 50: 254–8.
Roesch RP, Stoelting RK, Lingeman JE, Kahnoski RJ, Backes DJ, Gephardt SA. Ammonia toxicity resulting from gylcine absorption during a transurethral resection of the prostate. Anesthesiology 1983; 58: 577–9.
Wang JM, Wong KC, Creel DJ Clark WM, Shahangian S. Effects of glycine on hemodynamic responses and visual evoked potentials in the dog. Anesth Analg 1985; 64: 1071–7.
Osborne GA, Rudkin GE, Moran P. Fluid intake in laser endometrial ablation. Anaesth Intensive Care 1991; 19: 217–9.
Hasham F, Garry R, Kokri MS, Mooney P. Fluid absorption during laser ablation of the endometrium in the treatment of menorrhagia. Br J Anaesth 1992; 68: 151–4.
Bella FA, Sotos JF. Cerebral oedema in diabetic ketoacidosis in children (Letter). Lancet 1990; 336: 64.
Rother KI, Schwenk WF II. Effect of rehydration fluid with 75 mmol/L of sodium on serum sodium concentration and serum osmolality in young patients with diabetic ketoacidosis. MayoClin Proc 1994; 69: 1149–53.
Lewis BV. Guidelines for endometrial ablation. Br J Obstet Gynaecol 1994: 101: 470–3.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by a grant from The Foothills Hospital Foundation.
Rights and permissions
About this article
Cite this article
Moir, C.L., Mandin, H. & Brant, R. Sorbitol 2.5% mannitol 0.54% irrigation solution for hysteroscopic endometrial ablation surgery. Can J Anaesth 44, 473–478 (1997). https://doi.org/10.1007/BF03011933
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03011933