The use of glycine‐ethanol irrigating fluid for the early detection of fluid absorption during endometrial resection

Abstract

Objective To evaluate the use of 1.5% glycine with 1% ethanol as a marker to detect fluid absorption during endometrial resection. Design Prospective study. Setting Department of Obstetrics and Gynaecology, Wycombe General Hospital, High Wycombe, UK. Subjects 60 women having an endometrial resection for menorrhagia under general anaesthesia. Intervention 1.5% glycine and 1% ethanol solution for irrigation. Main outcome measures Breath ethanol concentration preoperatively, at 5‐min intervals during endometrial resection and 30 and 60 min postoperatively as measured by a hand‐held breath alcohol meter. Blood ethanol concentration, urea and electrolytes and serum ammonia were analysed at the start and the end of the procedure, and at 30 and 60 min postoperatively. Results There was a strong positive correlation (rs=0.93, P<0.000001) between the breath ethanol concentration at the end of the procedure and the total fluid absorbed. Breath ethanol measurements were able to detect absorption of 130 ml or more. Blood ethanol measurements showed the breath ethanol measurements to be reliable. There were no adverse effects attributable to the alcohol. The fall in serum sodium from the start of the operation to the end was the most useful biochemical marker of fluid absorption (rs=0.86, P<0.000001). The rise in serum ammonia from the start of the endometrial resection to the end correlated relatively poorly with fluid absorption (rs=0.44, P=0.00058) and there was no correlation between the ammonia level at the end of the procedure and fluid absorption (rs=0.06, P=0.64). Conclusions 1.5% glycine with 1% ethanol solution provides a safe, effective and noninvasive screening test for the detection of fluid absorption during endometrial resection.