Ethanol monitoring of irrigating fluid absorption in transcervical resection of the endometrium.
ABSTRACT We evaluated the precision in using ethanol to indicate and quantify absorption of irrigating fluid during transcervical resection of the endometrium.
The ethanol concentration in the expired breath, the serum sodium level, the blood loss and the volumetric fluid balance were measured over 10-min periods during 62 operations. A solution containing glycine 1.5% and ethanol 1% was used to irrigate the uterus.
Most principles previously outlined for ethanol monitoring in transurethral prostatic surgery could also be applied in endometrial resection. In the 21 patients who showed the intravascular pattern of ethanol changes, the breath alcohol measurement corrected for absorption time predicted the volume of irrigant absorbed (up to 2,531 ml) with a standard error of 230 ml at the end of any 10-min period of absorption. Repeated measurement of serum sodium indicated intravascular fluid absorption with practically the same precision as the breath test. Extravascular absorption was found in 14 patients. In these operations, the volume of irrigant absorbed (up to 1,767 ml) could be predicted with a standard error of 92 ml from the ethanol concentration at the plateau level attained after absorption had occurred.
Ethanol monitoring is precise enough to allow monitoring of irrigating fluid absorption in endometrial resection.
- Acta Anaesthesiologica Scandinavica 09/2008; 52(7):1026-7. · 2.36 Impact Factor
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ABSTRACT: We studied whether nitrous oxide (N(2)O) added to a fluid allows the infused volume to be quantified by measuring N(2)O in the expired air during normal breathing. If so, N(2)O might serve as a tracer of fluid absorption during endoscopic surgery. Twelve male volunteers received continuous and intermittent i.v. infusions (5-45 min) of fluid containing 40 ml litre(-1) of N(2)O. Breath N(2)O and CO(2) concentrations were measured every second via a flared nasal cannula, a standard nasal cannula, or a Hudson mask. An expression for the amount of infused fluid was obtained by calculating the area under the N(2)O concentration-time curve for samples representative for exhalation (CO(2)>median) and then dividing this area by the median CO(2) for the remaining samples. The N(2)O method then estimated fluid volumes of between 50 and 1400 ml within a 95% prediction interval of +/-200 ml. There were differences of up to 14% in results between the airway devices tested, but the volunteers preferred the flared nasal cannula. N(2)O showed a distinctly higher 3 min variability during intermittent infusion, which could indicate whether fluid absorption is directly intravascular or extravascular. No adverse effects were seen. N(2)O method does not require forced end-expiratory breath sampling but still predicts an administered fluid volume with high precision. N(2)O variability can probably be used to distinguish immediately between intravascular and perivesical fluid absorption during surgery.BJA British Journal of Anaesthesia 02/2007; 98(1):53-9. · 4.24 Impact Factor
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ABSTRACT: To challenge the view that the hyponatremia resulting from absorption of glycine 1.5% is attributed to the expansion of the extracellular fluid (ECF) volume, and that the change in serum sodium is therefore widely used to calculate the amount of irrigant absorbed. Retrospective analysis of six studies. University-affiliated hospital. Approximately 1.2 L of glycine 1.5% was infused in 23 volunteers (two studies), 1 L in 10 prostatectomy patients, 2.4 L in 6 sheep, 4 L in 6 other sheep, and 3 L in 9 piglets. The distribution of the irrigant water was estimated from the difference between the measured and the expected serum sodium levels, taking into account the urinary losses of sodium and water. Between 30% and 50% of the irrigant volume had diffused into the cells 30 minutes after the infusion, and only between 0% and 50% of the fluid remained in the ECF. One hour later, natriuresis accounted for 100% of the residual hyponatremia in the small-volume experiments, and it accounted for approximately 50% in the large-volume experiments. The change in serum sodium could not be used to quantify the small infusion volumes, but the large ones could be quantified fairly accurately if assessed at the very end of the infusion. Diffusion of water into the cells and natriuresis reduced and prolonged the hyponatremia associated with infusions of glycine 1.5%. This finding makes IV fluid with sodium added a more rational alternative than furosemide in the treatment of fluid overload with this irrigating solution.Journal of Clinical Anesthesia 06/2001; 13(3):167-74. · 1.15 Impact Factor