The effect of a mixture of 2.7% sorbitol-0.54% mannitol solution on blood coagulation: an in-vitro, observational healthy-volunteer study using rotational thromboelastometry (ROTEM) / 대한마취과학회지

BACKGROUND: We investigated the effect of irrigation fluid on coagulation according to the hemodilution level using rotational thromboelastometry (ROTEM). METHODS: Venous blood was taken from 12 healthy volunteers and divided into four specimen tubes that were diluted to various levels (0%, 10%, 20%, and 40%) using an irrigation fluid composed of 2.7% sorbitol and 0.54% mannitol. RESULTS: Significant prolongation of clotting time was observed in the 40% diluted sample using both INTEM (P = 0.009) and EXTEM (P = 0.001) assays. However, the clot formation time was prolonged significantly in the 10%, 20%, and 40% diluted samples using both INTEM (P < 0.001) and EXTEM (P = 0.002, P < 0.001, and P < 0.001, respectively) assays. A significant decrease of α-angle of INTEM and EXTEM were observed in the 10% (P < 0.001), 20% (P < 0.001 and P = 0.001, respectively), and 40% (P < 0.001) groups compared with the 0% dilution group. The maximum clot firmness (MCF) of INTEM decreased significantly in the 20% (P < 0.001) and 40% (P < 0.001) diluted samples. In the MCF of EXTEM and FIBTEM assays, 10% (P = 0.009 and P = 0.015, respectively), 20% (P = 0.001), and 40% (P < 0.001) samples showed a significant decrease compared with the 0% sample. Nevertheless, most of the ROTEM values were within the reference range, except the 40% sample. CONCLUSIONS: Blood became hypocoagulable when it was diluted in vitro with a fluid composed of 2.7% sorbitol and 0.54% mannitol.

Impact of different irrigation time on oxygenation index and acid-base balance during percutaneous neph-rolithotomy / 临床麻醉学杂志

Objective To investigate the impact of different irrigation time on oxygenation in-dex and acid-base balance during percutaneous nephrolithotomy(PCNL).Methods Forty patients un-dergoing selective PCNL were included in this study,were divided into two groups:group S,irrigation time<120 min(n=22);group L,irrigation time≥120 min(n=18).PaO2/FiO2 ,pH and BE were determined before and after irrigation,CVP were recorded before irrigation and every 20 min during irrigation. Results The CVP maximum value were higher in group L than that in group S during irrigation (P <0.05).The PaO2/FiO2 were lower after irrigation than that before irrigation in group L(P<0.05).The pH and BE were lower in group L than that in group S after irrigation(P<0.05).Conclusion Irrigation fluid absorption is observed during PCNL.That can provoke oxygenation function decline and metabolic ac-idosis with irrigation time extend,the operation time properly shortened.

Rapid Chondrolysis of Knee Joint after Arthroscopy Using Radiofrequency Device / 대한정형외과학회잡지

We report the cases of 3 young individuals, each of whom presented to our hospital for the evaluation and treatment of sudden onset chondrolysis. Previously, all 3 individuals had undergone arthroscopic knee procedures over a similar time at another hospital. In this paper, we review the possible problems that cause chondrolysis during or after arthroscopic procedures, such as the followings: use of thermal treatment, occult infection with Propionibacterium acnes, idiopathic or iatrogenic osteochondral injury, high temperature of fluid during arthroscopic irrigation, improperly placed implants, and the use of an intra-articular pain pump. We can exclude other causes of chondrolysis through the clinical course of the patients and surgical records and progress records. We conclude that the possible cause of chondrolysis in all cases was due to thermal injury caused by high temperatures, which decreased or blocked the irrigation fluid flow generated during arthroscopy.

Fatal Pulmonary Edema During Arthroscopic Shoulder Surgery / 대한법의학회지

Arthroscopic shoulder surgery is generally accepted as a popular tool for diagnostic and therapeutic approach to various shoulder lesions. Arthroscopic surgery is well known for its safety, less invasiveness and rare complication, but it can also cause life-threatening events which include soft tissue edema surrounding airway, pulmonary embolism, pneumothorax and so on. The author experienced a fatal case of pulmonary edema during shoulder arthroscopic surgery which resulted from leakage of irrigation fluid. The course of arthroscopic procedure, clinical progression and special attention for forensic pathologists and clinicians will be discussed.

Pulmonary edema and hyponatremia after hysteroscopic uterine septectomy : A case report

The hysteroscope has become a standard part of gynecologists' armamentarium, and hysteroscopy is taught routinely in residency curriculums. In recent years, its use in gynecology has changed from a diagnostic tool only to an instrument for gynecologic operations. An electrolyte-free irrigation fluid is used for hysteroscopic surgery, and it has a possibility of substantial absorption of irrigation fluid. The absorption depends on the rate, volume and nature of the irrigation fluid. Fortunately, large-scale fluid absorption is rare but leads to symptoms severe enough to require intensive care. Several methods have been proposed to reduce the risk but none of them is capable of preventing the complication from fluid absorption. In this case, the patient had pulmonary interstitial edema with hyponatremia after hysteroscopic uterine septectomy but that had resolved without sequelae.

Is the ability to perform transurethral resection of the prostate influenced by the surgeon's previous experience?

PURPOSE: To evaluate the influence of the urologist's experience on the surgical results and complications of transurethral resection of the prostate (TURP). PATIENTS AND METHODS: Sixty-seven patients undergoing transurethral resection of the prostate without the use of a video camera were randomly allocated into three groups according to the urologist's experience: a urologist having done 25 transurethral resections of the prostate (Group I - 24 patients); a urologist having done 50 transurethral resections of the prostate (Group II - 24 patients); a senior urologist with vast transurethral resection of the prostate experience (Group III - 19 patients). The following were recorded: the weight of resected tissue, the duration of the resection procedure, the volume of irrigation used, the amount of irrigation absorbed and the hemoglobin and sodium levels in the serum during the procedure. RESULTS: There were no differences between the groups in the amount of irrigation fluid used per operation, the amount of irrigation fluid absorbed or hematocrit and hemoglobin variation during the procedure. The weight of resected tissue per minute was approximately four times higher in group III than in groups I and II. The mean absorbed irrigation fluid was similar between the groups, with no statistical difference between them (p=0.24). Four patients (6 percent) presented with TUR syndrome, without a significant difference between the groups. CONCLUSION: The senior urologist was capable of resecting four times more tissue per time unit than the more inexperienced surgeons. Therefore, a surgeon's experience may be important to reduce the risk of secondary TURP due to recurring adenomas or adenomas that were incompletely resected. However, the incidence of complications was the same between the three groups.

Developed Extrapotine Myelinolysis after Hysteroscopic Myomectomy: A case report / 대한마취과학회지

Transcervical resection of endometrium is under-utilized in the treatment of dysfunctional uterine bleeding, uterine myoma and menorrhagia. The procedure is similar to transurethral resection of prostate in men with a possibility of substantial absorption of irrigation fluid. Absorption of a large volume of fluid can cause excessive intravascular volume, hyponatremia, cerebral edema and death. Severe hyponatremia leading to extrapontine myelinolysis is an extremely rare complication of this procedure. So, We report a case of developed extrapontine myelinolysis after hysteroscopic myomectomy which, however, showed complete recovery.

Effects of perioperative hypothermia on patients’ vital signs during TURP / 中华泌尿外科杂志

Objective To evaluate the effects of unwarmed and warmed irrigation fluid on patients’ vital signs during transurethral resection of the prostate (TURP),and to investigate the related factors affecting the safety of TURP. Methods A total of 100 patients were randomly assigned to receive unwarmed (21℃,n=40)or warmed (37 ℃,n=60)irrigation fluid during TURP.Pre-operatively,their age,body weight,IPSS,ratios of heart, brain, lung complications,intra-operative anesthesia modes,irrigation time, irrigation fluid amount,resected prostate weight and blood transfusion amount were not significantly different between the 2 groups. Intra-operatively,their mean arterial pressure (MAP),heart rate(HR),body temperature(T),blood oxygen saturation (SaO 2) and osmotic pressure of plasma (Osm) were observed dynamically based on the operating time. Results In patients of unwarmed group,after 45 min in the process of TURP,on an average MAP was decreased by 7.6 mm Hg (1 mm Hg=0.133 kPa;F=1.334,P=0.262);HR was reduced by 21.6/min (P

Effects of the temperature of irrigation fluid on body temperature and cardiovascular performance during transurethral surgery / 中华泌尿外科杂志

Objective To evaluate the effects of temperature of the irrigation fluid on body temperature and cardiovascular performance during transurethral surgery. Methods 87 cases were randomly divided into two groups according to the temperature of irrigation fluid used: the ambient (21～ 24 ℃) and the isothermic (35～36 ℃). Body temperature, blood glucose, ECG, HR, SaO 2, cardiac output (CO), mean arterial pressure (MAP) and systemic vascular resistance (SVR) were monitored during the transurethral surgery. Results Body temperature was decreased 2.1 ℃, MAP elevated, CO decreased and SVR increased in the ambient group, while body temperature was decreased only 0.3 ℃ and cardiac performance was maintained relatively stable in the isothermic group. Conclusions Hypothermia, resulted from the use of large amount of low temperature irrigation fluid during transurethral surgery has detrimental effects on body temperature and cardiovascular performance. Isothermic irrigation fluid would stablize the cardiovascular performance and so increases the safety of transurethral surgery.

The Effect of Warm Irrigation Fluid on Body Temperature during Laparoscopic Surgery in Gynecologic Patients / 대한마취과학회지

BACKGROUND: Perioperative hypothermia is a common problem during both laparotomy and laparoscopic surgery. Hypothermia during laparoscopic surgery is related to the use of irrigation fluid and the large volume of CO2 for maintaining pneumoperitoneum. The aim of this study is to estimate whether the use of warm irrigation fluid can reduce the incidence of hypothermia and the decrease of body temperature. METHODS: Forty-two female patients undergoing elective laparoscopic surgery were randomly divided into 2 groups. Group 1 (n = 20) was given an ambient temperature irrigation fluid and group 2 (n = 22) a warm irrigation fluid. The core esophageal body temperatures of all the patients were measured every 10 minutes for 70 minutes. Body temperature 10 minutes after induction was a control value. The degree of body temperature decrease was measured, and the incidence of hypothermia was recorded. RESULTS: The incidences of hypothermia in group 2 were decreased significantly 60 and 70 minutes after induction, compared with those of group 1. The degree of body temperature decrease was revealed to be significantly different between the two groups starting 50 minutes after induction. CONCLUSIONS: The use of warm irrigation fluid during laparoscopic surgery can reduce the incidence of hypothermia and degree of body temperature decrease.

The Effect of Warm Irrigation Fluid on Body Temperature during Laparoscopic Surgery in Gynecologic Patients / 대한마취과학회지

BACKGROUND: Perioperative hypothermia is a common problem during both laparotomy and laparoscopic surgery. Hypothermia during laparoscopic surgery is related to the use of irrigation fluid and the large volume of CO2 for maintaining pneumoperitoneum. The aim of this study is to estimate whether the use of warm irrigation fluid can reduce the incidence of hypothermia and the decrease of body temperature. METHODS: Forty-two female patients undergoing elective laparoscopic surgery were randomly divided into 2 groups. Group 1 (n = 20) was given an ambient temperature irrigation fluid and group 2 (n = 22) a warm irrigation fluid. The core esophageal body temperatures of all the patients were measured every 10 minutes for 70 minutes. Body temperature 10 minutes after induction was a control value. The degree of body temperature decrease was measured, and the incidence of hypothermia was recorded. RESULTS: The incidences of hypothermia in group 2 were decreased significantly 60 and 70 minutes after induction, compared with those of group 1. The degree of body temperature decrease was revealed to be significantly different between the two groups starting 50 minutes after induction. CONCLUSIONS: The use of warm irrigation fluid during laparoscopic surgery can reduce the incidence of hypothermia and degree of body temperature decrease.