Hemodynamic Changes During Operative Hysteroscopy
Condition: Hypertension
MeSH terms: Hypertension
Study type: Interventional
Phase: Phase 2

Summary: 
      Hysteroscopy is a minimally invasive gynaecological procedure in which an endoscopic optical
      lens is inserted through the cervix into the endometrial cavity to assists in the diagnosis
      of a vast number of uterine pathologies Historically, urologists used the resectoscope to
      perform a transurethral prostatectomy. This instrument was later modified to accommodate
      gynaecological applications. Operative hysteroscopy became popular after improvements in
      endoscopic technology and instruments in the 1970s and after the introduction of fluid
      distension media in the 1980s (1). During the past 2 decades, hysteroscopy has been
      increasingly used for operative procedures
    

Detailed description: 
      Operative hysteroscopy has become a standard surgical treatment for abnormal uterine bleeding
      unresponsive to conservative medical management since it was shown as a safe and effective
      alternative to hysterectomy.(2,3) Monopolar resectoscope necessitates an irrigating fluid
      that should be a non-conductive and salt free solution such as glycine 1.5% or sorbitol
      3%.(4) Physiologic irrigating fluids (e.g. saline 0.9%) are contraindicated with these
      instruments since electric current generated by any monopolar electro surgical unit is
      preferentially conducted through low impedance fluid rather than through tissue and
      consequently it's difficult to initiate cutting and impossible to create significant tissue
      coagulation with these devices The clinical drawback of non-conductive irrigating solution
      (e.g. glycine 1.5%) is the risk of excessive fluid absorption leading to symptomatic
      dilutional hyponatremia and for hypotonic solutions, hypo-osmolarity and secondary cerebral
      oedema as Glycine is metabolized to carbon dioxide, water and ammonia, and may lead to
      intra-cellular over hydration and neurotoxicity which is clinically reflected as hypoxemia,
      agitation, nausea and hypertension.(5).Although rare, irreversible neurologic damage and
      death have been reported after excessive absorption of salt free irrigating solutions during
      routine operative hysteroscopy(6)Theoretically, distension with 0.9% saline as a distension
      medium avoids most of the above mentioned risks associated with hyper absorption of non
      electrolytic distension media(7) However, there is no doubt that excessive absorption of
      normal saline can be fatal(8).

      Recently , it has been suggested that the type of anesthesia could modify fluid
      absorption(9). General anaesthesia has been associated with less Glycine absorption than
      epidural anaesthesia: the latter being associated with systemic vasodilatation(9).
    

Intervention name(s): Normal Saline 0.9% Infusion Solution Bag; 1.5% Glycine only
Intervention type(s): Drug; Drug
Intervention description(s): 0.9% saline as distension medium as long as diathermy is not in use; 1.5% Glycine alone during hysteroscopy as long as diathermy is in use
Intervention MeSH terms: Glycine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary purpose: Prevention