Hysteroscopy is a procedure that may appear minimally invasive, but may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for the visualization of the endometrium. Fluid overload due to the absorption of distention media during hysteroscopy can cause mild to severe complications, including hyponatremia, hypoosmolarity, nausea, vomiting, headache, arrhythmia, blindness, confusion, seizure, cerebral edema, brain herniation, and death. We report a case of a 41 year-old female patient who underwent elective hysteroscopic myomectomy under general anesthesia. Approximately 4 hours after the beginning of the surgery, the patient's serum sodium concentration dropped to 109 mM. She was treated with furosemide and recovered without sequelae.
Absorption ; Anesthesia, General ; Arrhythmias, Cardiac ; Blindness ; Brain ; Brain Edema ; Endometrium ; Female ; Furosemide ; Headache ; Humans ; Hyponatremia ; Hysteroscopes ; Hysteroscopy ; Nausea ; Seizures ; Sodium ; Vomiting

BACKGROUND: 2.7% sorbitol-0.54% mannitol has been selected as an alternative irrigating fluid during endoscopic surgery for its theoretical advantages. We compared the influence of 2.7% sorbitol-0.54% mannitol (Urosol(TM), CJ Pharma, Seoul, Korea) and 5% glucose as an irrigating solution for hysteroscopic myomectomy & polypectomy in the occurrence of associated complications. METHODS: Thirty patients scheduled for a hysteroscopic operation were included in a prospective randomized trial comparing 2.7% sorbitol-0.54% mannitol solution (Group S, n = 15) and 5% glucose (Group G, n = 15) as an irrigating fluid. We recorded the amount of the irrigating fluids, the amount of fluid intake, and the duration of the procedure. Serum sodium, chloride, potassium, glucose values, and serum osmolality were measured before (just after the induction, T1), during (when 2 L of irrigation fluid was infused, T2), and after (1 h after the end of the operation, T3) the hysteroscopic procedure. RESULTS: The mean volume of absorbed irrigating fluid was 185.0 +/- 73.5 ml in Group G and 175.4 +/- 50.5 ml in Group S. Transient hyperglycemia occurred in one patient of Group G. No differences were found in the intraoperative and postoperative levels of serum sodium, potassium, chloride, glucose and osmolality in both groups. CONCLUSIONS: There was no clinical evidence of hyponatremic hypoosmolality in any of the patients. We found no difference between 2.7% sorbitol-0.54% mannitol and 5% glucose as an irrigating fluid for hysteroscopic procedures with mild to moderate irrigant absorption.
Absorption ; Glucose ; Humans ; Hyperglycemia ; Hysteroscopy ; Mannitol ; Osmolar Concentration ; Plasma ; Potassium ; Potassium Chloride ; Prospective Studies ; Sodium

Pulmonary embolism is a not uncommon perioperative complication that results in substantial morbidity and mortality. However prompt diagnosis is difficult because clinical symptoms and signs of pulmonary embolism are not completely obvious. We report a case of severe pulmonary embolism on the first postoperative day of total abdominal hysterectomy in a patient transfused preoperatively for iron deficiency anemia caused by menorrhagia. We diagnosed pulmonary embolism by echocardiogram and chest spiral computerized tomography and the patient was moved to the intensive care unit. Tissue plasminogen activator was given and followed by continuous heparin infusion but the patient did not improve. He developed multiple organ dysfunction syndrome and died on the seventh postoperative day.
Anemia ; Anemia, Iron-Deficiency ; Female ; Heparin ; Humans ; Hysterectomy ; Intensive Care Units ; Menorrhagia ; Multiple Organ Failure ; Postoperative Complications ; Pulmonary Embolism ; Thorax ; Tissue Plasminogen Activator ; Tomography, Spiral Computed

BACKGROUND: For ophthalmic surgery anesthesia, it is vital that intraocular pressure (IOP) is controlled. Most anesthetic drugs affect IOP dose-dependently, and inhalational anesthetics dose-dependently decrease IOP. In this study, we compared the effects of desflurane and sevoflurane on IOP and hemodynamics in pediatric ophthalmic surgery. METHODS: Thirty eight pediatric patients from the age of 6 to 15 years, who were scheduled for strabismus surgery and entropion surgery, were randomized to be administered desflurane (group D, n = 19) or sevoflurane (group S, n = 19). IOPs and hemodynamic parameters were measured before induction of anesthesia (B), after induction but immediately before intubation (AI), 1 min after intubation (T1), 3 min after intubation (T3), and 5 min after intubation (T5). RESULTS: The mean arterial pressure (MAP) at T1 and heart rates (HRs) at T1 and T3 were significantly higher in group D than those in group S. There was no significant difference between the groups in IOP, cardiac index (CI) and stroke index (SI). There was a significant difference within the group in IOP, SI, MAP and HR. There was no significant difference within the group in CI. CONCLUSIONS: There was no significant difference between the groups in IOP and hemodynamic parameters. The two anesthetic agents maintained IOP and hemodynamic parameters in the normal range during anesthetic induction.
Anesthesia ; Anesthetics ; Arterial Pressure ; Entropion ; Heart Rate ; Hemodynamics ; Humans ; Intraocular Pressure ; Intubation ; Intubation, Intratracheal ; Isoflurane ; Methyl Ethers ; Reference Values ; Strabismus ; Stroke

No abstract available.
Laparoscopy ; Respiratory Mechanics

BACKGROUND: During ophthalmologic surgery, various intravenous anesthetic induction agents are used to prevent an intraocular pressure (IOP) increase. This study was designed to compare the effects of vecuronium and rocuronium on IOP in patients who were intubated. METHODS: Thirty-two patients undergoing elective strabismus surgery, aged 4 to 12 years, were randomized to receive rocuronium 0.6 mg/kg (Group 1, n = 16), or vecuronium 1.0 mg/kg (Group 2, n = 16).IOP, mean arterial pressure (MAP), and heart rate (HR) were measured at the following time points: prior to induction (B); after the administration of the induction agents; before intubation (T0); and at 1, 3 and 5 mins after intubation (T1, T3 and T5). RESULTS: The IOP after T0 in Group 1 was significantly lower than B (P < 0.05) in Group 2.The IOP at T1 in the Group 1 and 2 was not different from B, respectively.The IOP, MAP, and HR at T1 in the Groups 1 and 2 were significantly higher than at T0 (P < 0.05).No significant differences were observed between the groups in term of IOP. CONCLUSIONS: We concluded that vecuronium and rocuronium are both useful as muscle relaxants for use in general anesthesia in ophthalmologic surgery, because both agents caused similar decreases in intraocular pressure.
Aged ; Androstanols ; Anesthesia, General ; Arterial Pressure ; Heart Rate ; Humans ; Intraocular Pressure ; Intubation ; Muscles ; Strabismus ; Vecuronium Bromide