Biochemical hemodynamic and hematological changes during transcervical resection of the endometrium using 1.5% glycine as the irrigating solution.
OBJECTIVE
To study fluid absorption during transcervical resection of the endometrium (TCRE) and its effect on the biochemical, hemodynamic and hematological alterations so that life threatening complications of fluid overload may be prevented.


METHODS
Intraoperative fluid (1.5% glycine) absorption in 46 women undergoing TCRE was studied and correlated using biochemical parameters (serum sodium, potassium, total proteins, creatinine and blood urea), hemodynamic parameters (pulse rate, blood pressure, oxygen saturation and end tidal CO2) and hematological parameters. Twenty five of these patients had received danazol (800 mg/day) for six weeks prior to TCRE.


RESULTS
The mean glycine deficit during TCRE was found to be 474.45 ml, with a mean total inflow of 3802.17 ml. Amongst all of the parameters, only serum sodium levels were found to be significantly inversely correlated with the glycine deficit. No case of hyponatremia occurred below a deficit of 1000 ml. Severe hyponatremia was reported in three cases (6.4%) and all three had a glycine deficit of more than 1000 ml. No case of pulmonary edema was noted. The mean glycine deficit was significantly lower (P=0.007) and the duration of procedure significantly shorter (P=0.0009) in the patients who had received danazol. None of the patients in the danazol group had fluid absorption of more than 1000 ml.


CONCLUSIONS
Close monitoring of fluid inflow and outflow should be done during TCRE. Above a deficit of 1000 ml, serum sodium should be measured to detect significant hyponatremia. The use of danazol for endometrial preparation also reduces the mean amount of fluid absorbed.
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi.
A
A
Kriplani
J
J
Nath
D
D
Takkar
Maya
H L
HL
Kaul
D001798:Blood Proteins / Q000378:metabolism; D002584:Cervix Uteri; D003404:Creatinine / Q000097:blood; D004717:Endometrium / Q000601:surgery*; D005260:Female; D005998:Glycine; D006439:Hemodynamics; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008595:Menorrhagia / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D011188:Potassium / Q000097:blood; D012964:Sodium / Q000097:blood; D012996:Solutions; D007507:Therapeutic Irrigation / Q000009:adverse effects*; D014508:Urea / Q000097:blood; D014883:Water-Electrolyte Imbalance / Q000175:diagnosis* / Q000209:etiology
D001798:Blood Proteins; D006454:Hemoglobins; D012996:Solutions; D014508:Urea; D012964:Sodium; D003404:Creatinine; D011188:Potassium; D005998:Glycine