Haemodynamic, biochemical and haematological changes during hysteroscopic myomectomy

Abstract

ABSTRACTObjective To record circulatory volume changes, hyponatraemia, decrease in plasma osmotic pressure, changes in blood picture and coagulation profile in correlation with the size of myoma during hysteroscopic myomectomy.Design A cross‐sectional prospective comparative study.Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt.Subjects Fifty patients undergoing hysteroscopic myomectomy where a balanced general anaesthetic technique was used.Interventions Patients were divided into two groups according to the size of the submucous myoma. Group A included 25 patients having small submucous myomas (3 cm or less). Group B included those having larger myomas (more than 3 cm). Hysteroscopic myomectomy was done using glycine 1.5% as an irrigating solution for all cases. Haemodynamic measurements included pulse, mean arterial blood pressure and central venous pressure (CVP). Cardiodynamic measurements using non‐invasive thoracic electrical bioimpedence (TEB) included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), end diastolic volume (EDV), end diastolic index (EDI), ejection fraction (EF), peak flow (PF), peak flow index (PFI) and systemic vascular resistance (SVR), arterial blood gases (PaO2, PaCO2), oxygen saturation by pulse oximeter and end tidal CO2 by capnogram. Serum sodium and potassium concentration, blood osmolarity, prothrombin time (PT), prothrombin concentration (PC), partial thromboplastine time (PTT), haemoglobin concentration (HB), haematocrite value (HCT) and platelet count (PLT) were also measured. Absorbed fluid volume and intrauterine pressure (IUP) were also measured.Main outcome measures Changes in haemodynamics, caerdiodynamics, blood gases and haematological measurements as measured preoperatively and every 15 min for 75 min.Results The trial showed statistically significant variations regarding haematological and biochemical variables, but it was not associated with clinical signs of hyponatraemia. No signs of cardiac overload or cerebral confusion in both groups. Group B was associated with significant hyponatraemia, increased CVP, hypo‐osmolarity, increased PT and PTT, and increased most of the cardiodynamic parameters.Conclusions Hysteroscopic myomectomy, despite being the most risky hysteroscopic procedure, can be safely performed in most cases following the safety precautions. Intraoperative fluid absorption, especially with large myomas, is the trigger of some systemic changes. The procedure should be performed by an experienced hysteroscopist using a quick technique with the least possible glycine volume and minimal intrauterine pressure to achieve the goal of a safe out‐patient minimal access surgery.