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Canadian Journal of Anaesthesia

, Volume 39, Issue 9, pp 975–979 | Cite as

Anaesthetic implications of 32% Dextran-70 (Hyskon®) during hysteroscopy: hysteroscopy syndrome

  • Devanand Mangar
Brief Reviews

Abstract

This review describes the properties and side effects of Hyskon® and the implications for the patient and anaesthetist during hysteroscopy. The amount of Hyskon® absorbed is dependent on the injection pressure, the extent of tissue trauma, the seal of the hysteroscope around the cervix, and the duration of infusion. The mechanism of pulmonary oedema after absorbtion of Hyskon® is fluid overload, and not injury to pulmonary capillary endothelium. The haematological effects are primarily due to haemodilution. However, case reports suggest that Dextran 70 may cause a syndrome resembling disseminated intravascular coagulation. The allergic response to Hyskon® consists of both an anaphylactic and an anaphylactoid component. It is recommended that hysteroscopy with Hyskon® be limited to 45 min, and that all possible measures be taken to minimize tissue trauma and bleeding. The volume of Hyskon® should be limited to less than 500 ml, since pulmonary oedema and coagulopathy have been described with even lesser amounts. The cumulative volume of Hyskon® should be monitored frequently and the patient should be closely monitored for signs of impending pulmonary oedema.

Key words

complications: pulmonary oedema surgery: gynaecological, hysteroscopy syndromes: hysteroscopy 

Résumé

Cet article décrit les propriétés et les effets secondaires de l’Hyskon® et les implications pour le patient et l’anesthesiste pendant l’hystéroscopie. La quantité d’Hyskon absorbée dépend de la pression dinjection, de l’extension du traumatisme tissulaire, de l’étanchéité de l’hystéroscope inséré dans le col et de la durée de la perfusion. Le mécanisme de Voedème pulmonaire après la résorbtion d’Hyskon est une surcharge liquidienne et non une lésion endothéliale des capillaires pulmonaires. Les effets hématologiques sont d’abord dus à l’ hémodilution bien que des rapports de cas suggèrent que le dextran 70 peut causer d’emblée une coagulation intravasculaire disséminée. La réponse allergique à l’Hyskon comporte à la fois un versant anaphylactique et anaphylactoïde. On recommande que l’hysteroscopie à l’Hyskon soit limitée à 45 minutes et que soient pris tous les moyens possibles pour diminuer le traumatisme tissulaire et le saignement. Le volume d’Hyskon doit être limité à moins de 500 ml puisque l’oedème pulmonaire et la coagulopathie ont été même décrits pour des quantités moindres. La quantité perfusée d’Hyskon devrait être régulière comptabilisée et le patient devrait être étroitement monitorisé quant aux signes précurseurs d’oedème pulmonaire.

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Copyright information

© Canadian Anesthesiologists 1992

Authors and Affiliations

  • Devanand Mangar
    • 1
  1. 1.Department of AnesthesiologyUniversity of South Florida College of MedicineTampa

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