Abstract
Purpose and source
Hysteroscopy has become a widely accepted technique in the diagnosis and treatment of various gynaecological conditions. The advent of the fibreoptic endoscope and distending media has largely been responsible for the increasing use of hysteroscopy. It is our aim in this article to review the literature on the frequently used distending media such as carbon dioxide, glycine, dextran, dextrose, sorbitol and mannitol and their anaesthetic implications.
Principal findings
The endoscopist chooses the particular medium. Complications due to the distending media occur in <4% of cases. Dilutional hyponatraemia and hypothermia are commonly encountered complications and, in addition, hyperglycaemia and volume expansion can occur. Less commonly-encountered complications are embolism with carbon dioxide and pulmonary oedema, renal failure and in rare cases anaphylaxis and encephalopathy. Regional anaesthesia may offer an advantage over general anaesthesia in early recognition of fluid accumulation. Appropriate monitoring should include fluid balance, routine monitoring as well as temperature, electrolytes and blood sugar measurements. Precordial Doppler measurement, central venous and/or pulmonary artery pressure measurement may be of help in detecting as well as treating carbon dioxide and/or air embolism and fluid balance in high risk patients.
Conclusions
There is no one commonly used medium and no one medium is devoid of complications. There have been no controlled studies comparing different anaesthetic techniques. Positioning of the patient can give rise to complications such as peripheral neuropathy. Hysteroscopy is a non invasive procedure which entails a short hospital course with minimal postoperative sequelae and may be cost saving.
Résumé
Objectif
L’hystéroscopie a maintenant fait ses preuves comme outil de diagnostic et de traitement en chirurgie gynécologique. L’introduction de l’endoscopie flbroptique et des substances qui servent à distendre les tissus (médiums de distension) est grandement responsable de l’augmentation de la faveur de l’hystéroscopie. L’objectif de cet article est de procéder à un survol de la littérature portant sur les méthodes de distension les plus employées comme l’insufflation de gaz carbonique, l’irrigation avec la glycine, le dextran, le dextrose, le sorbitol et la mannitol et leur conséquences sur l’anesthésie.
Principales constatations
C’est l’endoscopiste qui choisit le médium. Des complications due aux médiums de distension surviennent dans moins de 4% de cas. L’hyponatrémie dilutionnelle et l’hypothermie sont les complications les plus communes. On rapporte plus rarement l’hypervolémie et l’hyperglycémie. L’embolie gazeuse au gaz carbonique, l’oedème pulmonaire, l’insuffisance rénale sont aussi décrites et très rarement, l’anaphylaxie et l’encéphalopathie. L’anesthésie régionale peut présenter un avantage sur l’anesthésie générale en ce qui concerne la détection de l’accumulation de liquide. Une monitorage pertinent comprend le contrôle des liquides. Au monitorage de base s’ajoute de celui de la température et de la glycémie. Le Döppler précordial, la mesure la tension veineuse centrale et/ou de la pression artérielle pulmonaire peuvent être utiles pour détecter et traiter les embolies aériennes ou gazeuses et l’hypervolémie chez les patientes à haut risque.
Conclusions
On n ’utilise pas les mêmes médiums partout et aucun n ’est exempt de complications. Nous ne possédons pas d’études contrôlées qui comparent les techniques anesthésiques. La position de la patiente peut provoquer des neuropathies. L’hystéroscopie constitue un intervention non effractive qui nécessite peu de soins à l’hôpital et dont les coûts sont minimes.
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Ananthanarayan, C., Paek, W., Rolbin, S.H. et al. Hysteroscopy and anaesthesia. Can J Anaesth 43, 56–64 (1996). https://doi.org/10.1007/BF03015959
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DOI: https://doi.org/10.1007/BF03015959