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OBGYN > 11: HYSTEROSCOPIC COMPLICATIONS > Flashcards

11: HYSTEROSCOPIC COMPLICATIONS Flashcards

1
Q

Review viscosity of the following
0.9% NaCl
5% Mannitol
1.5% Glycine
3% Sorbitol
5% Glycine
5% Dextrose
Mannitol/Sorbitol
32% Dextran 70

A

All low viscosity with the exception of Dextran

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2
Q

Discuss the osmolality of the following
0.9% NaCl
5% Mannitol
1.5% Glycine
3% Sorbitol
5% Glycine
5% Dextrose
Mannitol/Sorbitol
32% Dextran 70

A

ISOTONIC:
0.9% NaCl
5% Mannitol (therefore less risks compared to mannitol/sorbitol

HYPOTONIC: 1.5% Glycine - Mannitol/Sorbitol

HYPERTONIC: Dextran

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3
Q

Discuss electrolyte status of the following
0.9% NaCl
5% Mannitol
1.5% Glycine
3% Sorbitol
5% Glycine
5% Dextrose
Mannitol/Sorbitol
32% Dextran 70

A

All electrolyte poor except 0.9% NaCl

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4
Q

Fluids for monopolar procedures

A

Glycine, Mannitol, Sorbitol

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5
Q

Review qualities of Dextran

A

High viscosity
Hypertonic
Electrolyte poor
Good visualization with bleeding

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6
Q

Risks of Dextran

A

Anaphylaxis, lack of availability, crystallization, max deficit 300-500cc

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7
Q

Dextran deficit

A

300-500cc

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8
Q

At what intrauterine pressure could fluid extravasate through fallopian tubes

A

> 75mmHg

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9
Q

Pressure of myometrial sinuses

A

10-15mmHg

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10
Q

Hypoosmolar hyponatremia:
What fluids cause this, and what are symptoms

A

Hypo-osmolar (hypotonic) fluids (ex: glycine, sorbitol)
Cerebral edema
Neurological impairment
Seizures
Death

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11
Q

Early vs late symptoms of hyponatremia

A

INITIAL:
HA, N/V, weakness

LATE:
Agitation, confusion, visual disturbances, lethargy, seizures, arrhythmias (including bradycardia), respiratory distress, death

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12
Q

SORBITOL:
Components
Risks
Symptoms

A

Sugar-containing hypo-osmolar solution
Risks: Hyperglycemia, hypocalcemia
Symptoms: Myoclonus, DKA (therefore avoid in diabetics)

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13
Q

Management of hyponatremia if asymptomatic and Na >120mmol/L

A

Fluid restriction
Loop diuretic (ex: Lasix)

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14
Q

Management of hyponatremia if symptomatic and/or Na <120

A

3% hypertonic NaCl
Serial metabolic profile
Supplemental O2
Foley catheter
ICU/anesthesia team management

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15
Q

Fluid deficit limits
Electrolyte-rich, isotonic
Electrolyte-poor, hypotonic

A

E-R/I: 2500cc healthy, 1500cc sick
E-P/H: 1000cc healthy, 750cc sick

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16
Q

Overall risk of complications HSC

A

0.22-0.28%

17
Q

Risk of hemorrhage with HSC

A

0.03%

18
Q

Management of localized bleeding HSC

A

If can visualize entire cavity and discreet bleeding noted, can coagulate

19
Q

Management of diffuse bleeding HSC

A

If no evidence of perforation, need tamponade (ex: bimanual massage or placement of balloon/catheter)

20
Q

Indications for observation with uterine perforation on HSC

A

If low-risk for vascular/visceral injury
If perforation with blunt instrument
Absence of significant bleeding

21
Q

Indications for laparoscopy with uterine perforation on HSC

A

If perforation with sharp instrument
Suction
Electrosurgical device
Significant bleeding
Risk of vascular or visceral injury warrants further assessment (laparotomy if unstable)

22
Q

Management of urinary tract injury on HSC

A

Intraoperative: Cystoscopy
Post-operative: CT urogram

23
Q

Management of intestinal tract injury on HSC

A

Intraoperative: LSC or laparotomy
Post-operative: CT scan

24
Q

Pathophysiology of vasovagal reaction

A

Increased cardio-vagal tone >
Bradycardia >
Decreased peripheral sympathetic activity >
Venous dilation >
Hypotension

25
Q

Incidence of vasovagal reaction

A

0.72-1.7%

26
Q

Subjective symptoms of vasovagal reaction

A

Lightheaded
Warm/cold
Sweating
Palpitations
Nausea
Vision changes
Hearing changes
Pallor

27
Q

Objective symptoms of vasovagal reaction

A

Bradycardia
Hypotension

28
Q

Management of vasovagal reaction

A

Vital signs
D/c procedure
Lower patient’s head
Fluid administration
Rare, but if other interventions don’t work - Atropine

29
Q

RFs for vasovagal

A

CO2 as distention media
Rigid instrumentation
Severe pain

30
Q

Reduce RFs for vasovagal

A

Use anesthesia
Smaller diameter scopes
Flexible HSC
Fluid distention media

31
Q

Pregnancy risks after ablation

A

Ectopic
Malpresentation
Prematurity
Abnormal placentation
Perinatal mortality

32
Q

Risk of post-ablation infection

A

<1%

33
Q

Post-ablation tubal ligation syndrome incidence

A

May be as high as 10%

34
Q

Possible sequelae of post-tubal ablation syndrome

A

Often need hysterectomy
Residual active endometrium in one or both cornua
Cavity disortion
Hematometra d/t obstruction/scarring

OBGYN (16 decks)

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