title: The impact of anesthesia on glycine absorption in operative hysteroscopy: a randomized controlled trial.
abstract: BACKGROUND
  Operative hysteroscopy requires the use of a distension medium and its absorption can lead to serious consequences from intravascular volume overload and water intoxication. We compared the impact of 2 types of anesthesia (general anesthesia and local anesthesia with sedation) on the absorption of glycine solution in operative hysteroscopy.
  
  
  METHODS
  A randomized controlled trial was conducted over a 17-month period. Eligible patients undergoing operative hysteroscopy for abnormal uterine bleeding were randomized in 2 groups: a general anesthesia group and a local anesthesia with sedation group. The primary outcome was the median absorption of the glycine solution (10th-90th percentile) measured with an automated tandem canister system. Secondary outcomes included incidence of absorption >1000 mL, discontinued surgery because of excessive absorption, median change in serum sodium, postoperative hyponatremia, and patients' postoperative quality of life at 24 hours (8-item Short Form Health Survey questionnaire). Nonparametric analyses (Mann-Whitney U test, χ(2) test, and Fisher exact test) were used.
  
  
  RESULTS
  Of 142 eligible patients, 95 agreed to participate and were randomized. Women who underwent general anesthesia had a higher median absorption of the glycine solution (10th-90th percentile) compared with women who underwent local anesthesia with sedation (480 mL [76-1300 mL] vs 253 mL [70-728 mL]; P = 0.005). General anesthesia was also associated with a higher rate of glycine solution absorption (>1000 mL [20% vs 4%; P = 0.009]) and a more rapid rate of decrease in serum sodium (≥10 mEq/L [8% vs 0%; P = 0.005]) than local anesthesia with sedation. Postoperative quality of life measures as rated by the patients were comparable between the 2 groups.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Québec, Pavillon CHUL, 2145 Blvd. Laurier, Québec, QC, Canada, G1V 4G2.
authors.forename: Marie-Eve
authors.initials: ME
authors.lastname: Bergeron
authors.forename: Pascale
authors.initials: P
authors.lastname: Ouellet
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: Maxime
authors.initials: M
authors.lastname: Cote
authors.forename: Caroline
authors.initials: C
authors.lastname: Rhéaume
authors.forename: Daniel
authors.initials: D
authors.lastname: Lapointe
authors.forename: Christine
authors.initials: C
authors.lastname: Beaudet
authors.forename: Madeleine
authors.initials: M
authors.lastname: Lemyre
authors.forename: Philippe
authors.initials: P
authors.lastname: Laberge
mesh_terms: D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects; D000772:Anesthesia, Local / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D005998:Glycine / Q000009:adverse effects / Q000493:pharmacokinetics*; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D015907:Hysteroscopy / Q000009:adverse effects; D008875:Middle Aged; D011788:Quality of Life; D011792:Quebec; D018570:Risk Assessment; D012307:Risk Factors; D007507:Therapeutic Irrigation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000601:surgery*; D014869:Water Intoxication / Q000209:etiology; D014883:Water-Electrolyte Imbalance / Q000209:etiology
chemical_list: D005998:Glycine