BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy TOG 2018 Flashcards
What distension media cannot be used if monopoly energy is to be used
Normal saline and ringers lactate - both isotonic
Previously when only monopolar devices non-isotonic distension mediums used
What is the main issue with non-isotonic distension mediums?
Excessive fluid abosrobtion, which can derange plasma osmolality with potentially life-threatening consequences
Which distension medium is high viscosity , hypotonic
Dextran 32%
- can cause anaphylacrsis and small absorbtion can cause IV expansion & cardiac failure
Which distension mediums are low viscosity and hypotonic?
1.5% glycine
3% sorbitol
5% dextrose
What is the consequences of vascular absorbtion of hypotonic fluids
Hypervolaemia
Dilatation hyponatraemia
Cerebral oedema
Pulmonary oedema
CHF
Hence 0.9% saline advised
What is the definition of fluid overload?
Hypotonic fluid >1000mls
Isotonic fluid >2500mls
if healthy women, reproductive age
Greater caution of elderly or CV disease e.g.
Hypotonic 750mls
Isotonic 1500mls
Fluid deficit threshold should be decided with anaesthetist pre op
How to manage fluid overload
Strict fluid balance chart
Urinary catheter
Serum electrolytes
If CHF/pulmonary oedema - ECHO, CXR
Asymtomatic - fluid restriction
Symptomatic - MDT approach, 3% hypertonic sodium chloride
Can carbon dioxide gaseous media be used in hysteroscopy
No
Measures to reduced fluid absorbtion
GnRH agonist pre-TCRF
Intracervical injection of dilute vasopressin
Minimum distension for adequate visualisation
How often should fluid deficit be calculated during hysteroesocpy
Every 10 mins
Automated flood measurements systems more accurate
What Dx to consider if sudden CV collapse during procedure
Gas or air embolism - sudden desaturation n
