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.
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ABSTRACT: To study the potential for dissemination of endometrial tissue substances during transcervical resection of the endometrium (TCRE). Prospective study. One university and two county hospitals. Forty-eight women with dysfunctional bleeding. The serum levels of two endometrial proteins, insulin-like growth factor binding protein-1 (IGFBP-1) and placental protein 14 (PP14), were measured before and every 10 min during the operations. Blood loss was also measured by a photometer together with absorption of the irrigating fluid containing glycine 1.5% and ethanol 1% by expired-breath tests, and serum sodium and volumetric fluid balances. Linear correlations between changes in IGFBP-1 and PP14 during TCRE and operating parameters such as operating time, blood loss and fluid absorption. The baseline levels of IGFBP-1 were normal but PP14 could only be detected in one third of the patients, which was due, in part, to pre-operative treatment with danazol. The highest levels of IGFBP-1 and PP14 during surgery correlated positively with the baseline concentrations. Fluid absorption (median 405 ml, range 0-2177) was the only surgical factor associated with increasing serum levels of endometrial proteins. Absorption of the solution used to irrigate the uterus is associated with dissemination of endometrial products in the bloodstream during TCRE.British Journal of Obstetrics and Gynaecology 06/1996; 103(5):442-5.
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ABSTRACT: Intraperitoneal absorption of electrolyte-free irrigating fluid may occur secondary to uterine perforation during endometrial resection, but the clinical course of this complication is known from only a few case reports. We studied symptoms, biochemical changes and the kinetics of solute equilibration over the peritoneal membrane in 10 healthy awake women who were subjected to an experimental absorption situation by receiving an intraperitoneal infusion of 25 ml/kg of a solution containing glycine 1.5% and ethanol 1% over 20 min. We also compared the use of breath ethanol and serum sodium samples to indicate the presence of irrigating fluid in the peritoneal cavity. All infusions caused lower abdominal pain. The solute gradients between the peritoneal pool and plasma were reduced according to mono-exponential functions with a half-time of 33 +/- 5 min for ethanol, 92 +/- 9 min for sodium, 103 +/- 9 min for potassium, and 124 +/- 10 min for amino acids (mean +/- s.e.mean). Twenty minutes after infusion, the breath ethanol level reached a plateau which could be used to predict the infused volume within +/- 15% of the true value. In contrast, the serum sodium concentration decreased slowly and was only 3.0 +/- 0.7 mmol/l below baseline at 2 hours after infusion. The calculated rates of transperitoneal solute equilibration can be used to assess the need for substitution of electrolytes in patients who absorb irrigating fluid into the peritoneal cavity. Measurement of ethanol in the expired breath is more useful than serum sodium to indicate the existence of such a pool.Acta Obstetricia Et Gynecologica Scandinavica 11/1995; 74(9):707-13. · 1.85 Impact Factor
- Acta Anaesthesiologica Scandinavica 09/2008; 52(7):1026-7. · 2.36 Impact Factor