11: HYSTEROSCOPIC COMPLICATIONS Flashcards
Review viscosity of the following
0.9% NaCl
5% Mannitol
1.5% Glycine
3% Sorbitol
5% Glycine
5% Dextrose
Mannitol/Sorbitol
32% Dextran 70
All low viscosity with the exception of Dextran
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
ISOTONIC:
0.9% NaCl
5% Mannitol (therefore less risks compared to mannitol/sorbitol
HYPOTONIC: 1.5% Glycine - Mannitol/Sorbitol
HYPERTONIC: Dextran
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
All electrolyte poor except 0.9% NaCl
Fluids for monopolar procedures
Glycine, Mannitol, Sorbitol
Review qualities of Dextran
High viscosity
Hypertonic
Electrolyte poor
Good visualization with bleeding
Risks of Dextran
Anaphylaxis, lack of availability, crystallization, max deficit 300-500cc
Dextran deficit
300-500cc
At what intrauterine pressure could fluid extravasate through fallopian tubes
> 75mmHg
Pressure of myometrial sinuses
10-15mmHg
Hypoosmolar hyponatremia:
What fluids cause this, and what are symptoms
Hypo-osmolar (hypotonic) fluids (ex: glycine, sorbitol)
Cerebral edema
Neurological impairment
Seizures
Death
Early vs late symptoms of hyponatremia
INITIAL:
HA, N/V, weakness
LATE:
Agitation, confusion, visual disturbances, lethargy, seizures, arrhythmias (including bradycardia), respiratory distress, death
SORBITOL:
Components
Risks
Symptoms
Sugar-containing hypo-osmolar solution
Risks: Hyperglycemia, hypocalcemia
Symptoms: Myoclonus, DKA (therefore avoid in diabetics)
Management of hyponatremia if asymptomatic and Na >120mmol/L
Fluid restriction
Loop diuretic (ex: Lasix)
Management of hyponatremia if symptomatic and/or Na <120
3% hypertonic NaCl
Serial metabolic profile
Supplemental O2
Foley catheter
ICU/anesthesia team management
Fluid deficit limits
Electrolyte-rich, isotonic
Electrolyte-poor, hypotonic
E-R/I: 2500cc healthy, 1500cc sick
E-P/H: 1000cc healthy, 750cc sick
Overall risk of complications HSC
0.22-0.28%
Risk of hemorrhage with HSC
0.03%
Management of localized bleeding HSC
If can visualize entire cavity and discreet bleeding noted, can coagulate
Management of diffuse bleeding HSC
If no evidence of perforation, need tamponade (ex: bimanual massage or placement of balloon/catheter)
Indications for observation with uterine perforation on HSC
If low-risk for vascular/visceral injury
If perforation with blunt instrument
Absence of significant bleeding
Indications for laparoscopy with uterine perforation on HSC
If perforation with sharp instrument
Suction
Electrosurgical device
Significant bleeding
Risk of vascular or visceral injury warrants further assessment (laparotomy if unstable)
Management of urinary tract injury on HSC
Intraoperative: Cystoscopy
Post-operative: CT urogram
Management of intestinal tract injury on HSC
Intraoperative: LSC or laparotomy
Post-operative: CT scan
Pathophysiology of vasovagal reaction
Increased cardio-vagal tone >
Bradycardia >
Decreased peripheral sympathetic activity >
Venous dilation >
Hypotension
