<p>The Impact of Spinal Anesthesia and Use of Oxytocin on Fluid Absorption in Patients Undergoing Operative Hysteroscopy: Results from a Prospective Controlled Study</p>

Abstract

The aim of this study was to determine if combining intravenous oxytocin infusion and spinal anesthesia will reduce the amount of glycine absorption in patients undergoing operative hysteroscopy. Patients and Methods: A prospective controlled study was conducted in premenopausal patients who had hysteroscopic surgery including endometrial resection, endometrial polypectomy, myomectomy resection and uterine septal resection. The effect of combined spinal anesthetic with oxytocin infusion on fluid deficit was studied. Results: A total of 88 patients were studied. Sixty-two cases were done under general anesthesia (control group) and 26 cases were performed with spinal anesthesia and the use of oxytocin infusion (study group). There was a statistically significant less mean fluid deficit in the study group than control group in the endometrial polypectomy patients (220±36 mL vs 392±178 mL, respectively, P value 0.010, 95% C.I.: 163-276) and the myomectomy patients (308±66 mL vs 564±371 mL, respectively, P value 0.003, 95% C.I.: 239-378). In the endometrial resections, there was also a statistically significant less mean fluid deficit in the study than the control group (P value ˂ 0.001). Regarding septal resection, there was no statistically significant difference in the mean fluid deficit between the two groups (P value 0.833). Conclusion: Spinal anesthesia combined with intravenous oxytocin infusion in operative hysteroscopy results in a statistically significant reduction in the glycine fluid deficit than the general anesthesia. We also recommend studying the effects of this combination in operative hysteroscopy using bipolar devices with isotonic solutions.

Effects of spinal anaesthesia and intravenous general anaesthesia on the absorption of normal salinein patients undergoing hysteroscopic endometrial resection: an observational study

“…It was suggested that there was almost no difference in the effect of general anaesthesia and spinal anaesthesia on the blood pressure of patients during hysteroscopic surgery, regardless of the different absorption of glycine or the same absorption of normal saline. The main reason for this result is that the difference in the absorption of glycine between the two groups was only approximately 560 ml in previous studies [ 13 ]. Most of the hypotonic glycine solution absorbed into the vascular system was quickly transferred into the tissue and cells in the body, and the amount of glycine left in the circulatory system was relatively small, which had little effect on the circulation.…”

Acute Severe Hyponatremia following Hysteroscopic Procedure in a Young Patient: A Case Report and Review of the Literature

“…ere was a statistically significant less mean fluid deficit in the study group than the control group in endometrial polypectomy and myomectomy patients but not in those who underwent septal resection [21]. e 1.5% glycine is one of the most common solutions used in monopolar hysteroscopic procedures due to its nonhemolytic, nonconductive, and transparent properties, although it is more toxic and has poorer outcomes when confronted with other options [22].…”

“…They presumed that using low-dose oxytocin (10 international units (IUs) in 200 mL normal saline) would stimulate uterine contractions compressing the myometrial vessels and reduce the glycine absorption. There was a statistically significant less mean fluid deficit in the study group than the control group in endometrial polypectomy and myomectomy patients but not in those who underwent septal resection [ 21 ].…”

Pharmacologic Interventions to Minimize Fluid Absorption at the Time of Hysteroscopy

“…30 Al Husban et al compared neuraxial anesthesia with concomitant oxytocin infusion with general anesthesia alone and found significantly lower fluid deficit in the former group (mean deficit 439.25 mL vs 631.75 mL, P <.05); however, the presence of two variables in the intervention group confounds any further analysis. 35 Lastly, a study by Munmany et al published in 2016 compared propofol infusion with inhaled sevoflurane at the time of operative hysteroscopy and noted a significantly lower deficit for the group receiving propofol (median deficit 202 mL, range 60–542 mL vs median deficit 264, range 153–932, P =.007). 33…”