BIOCHEMICAL HEMODYNAMIC AND HEMATOLOGICAL-CHANGES DURING TRANSCERVICAL RESECTION OF THE ENDOMETRIUM USING 1.5-PERCENT GLYCINE AS THE IRRIGATING SOLUTION

Objective: To study fluid absorption during transcervical resection of the endometrium (TCRE) and its effect on the biochemical, hemodynamic and hematological alterations so that life threatening complications of fluid overload may be prevented. Method: Intraoperative fluid (1.5% glycine) absorption in 46 women undergoing TCRE was studied and corre lated using biochemical parameters (serum sodium, potassium, total pro teins, creatinine and blood urea), hemodynamic parameters (pulse rate, blood pressure, oxygen saturation and end tidal CO2) and hematologica l parameters. Twenty five of these patients had received danazol (800 mg/day) for six weeks prior to TCRE. Result: The mean glycine deficit during TCRE was found to be 474.45 ml, with a mean total inflow of 380 2.17 ml. Amongst ail of the parameters, only serum sodium levels were found to be significantly inversely correlated with the glycine defici t. No case of hyponatremia occurred below a deficit of 1000 ml. Severe hyponatremia was reported in three cases (6.4%) and all three had a g lycine deficit of more than 1000 ml. No case of pulmonary edema was no ted. The mean glycine deficit was significantly lower (P=0.007) and th e duration of procedure significantly shorter (P=0.0009) in the patien ts who had received danazol. None of the patients in the danazol group had fluid absorption of more than 1000 ml. Conclusion: Close monitori ng of fluid inflow and outflow should be done during TCRE. Above a def icit of 1000 ml, serum sodium should be measured to detect significant hyponatremia. The use of danazol for endometrial preparation also red uces the mean amount of fluid absorbed. (C) 1998 Elsevier Science Irel and Ltd.