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: 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. DOI:10.3109/00016349509021179
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ABSTRACT: Monitoring of ethanol concentration in expired air is a method for assessing fluid absorption during transurethral prostatic surgery and endometrial resection, but the validity of this technique has not been studied in low-flow ventilation systems. For this purpose, we have compared the concentration-time profiles of ethanol in expired gas and in venous blood during an i.v. infusion of 0.4 g kg-1 of ethanol over 30 min in 10 women during isoflurane anaesthesia and in the awake state. Anaesthesia increased the ethanol concentration in expired gas by 13% and in venous blood by 34%. The expired gas-blood difference during infusion was abolished, and the central volume of distribution for ethanol was reduced from 20.9 to 8.6 litre, on average. We conclude that breath sampling during low-flow isoflurane anaesthesia reflects an alcohol load well, but that a change in ethanol disposition makes the values slightly higher than in the awake state.BJA British Journal of Anaesthesia 02/1996; 76(1):85-9. DOI:10.1097/00132586-199704000-00061
- European Journal of Anaesthesiology 04/1996; 13(2):102-15. DOI:10.1046/j.1365-2346.1996.00942.x