ADDITION OF ETHANOL TO THE DISTENSION MED IUM IN OPERATIVE HYSTEROSCOPY AS SCREENING TO AVOID FLUID OVERLOAD A PROSPECTIVE RANDOMIZED COMPARATIVE-STUDY

For answering the question at which hysteroscopical procedures an intr aoperative screening method is necessary to avoid a fluid overload and whether a beginning fluid absorption can be diagnosed early by adding ethanol to the distension medium, a prospectively randomised comparat ive study of ablative versus non-ablative operative hysteroscopy with differing ethanol concentrations was performed (n=120), Purisole (a ma nnit/sorbit solution) was used a distension medium, The measuring para meters (breath alcohol, amount of absorbed fluid, haematocrit and haem oglobin values, central venous pressure, heart frequency) were intraop eratively determined at 5-minute intervals. The results of the study s how that with those hysteroscopical procedures during which the endome trium is not or only minimally injured (e.g. syneciolysis, hysteroscop ic proximal tubal catheterisation), intraoperative screening is not: n ecessary due to the low absorbing amounts. With hysteroscopical proced ures such as resection of myoma, endometrium ablation and septum resec tion, however, an addition of ethanol of 2% to the distension medium h as proved useful, because with this method absorption amounts of 400 m l and more can be detected by positive values of breath alcohol. As th e result of a further absorption of fluid, delayed in time compared to the first positive value of breath alcohol, there is an increase in c entral venous pressure and hyponatraemia. Intraoperative ethanol monit oring is a non-invasive procedure which can be performed during ablati ve-operative hysteroscopies and has no negative influence on the cours e of the intervention and the general condition of the patients.