Anesthesiology and Pain Medicine
Operative hysteroscopy intravascular absorption (OHIA) syndrome is caused by intravascular absorption of fluid distension/irrigation medium during hysteroscopy. There are very few reported cases of this syndrome using saline as irrigation fluid. The current report was on a case of severe OHIA syndrome that necessitated resuscitation in an intensive care unit (ICU).
A 41-year-old, 65-kg, smoker female patient was admitted for an endoscopic resection of submucous uterine myoma under general anesthesia using a laryngeal mask airway. In the 50th minute of the procedure, end-tidal CO2 dropped from 35 to 25 mmHg and pulse oximetry (SpO2) from 100% to 90%. Crackling sounds were heard from the base of the lungs. As a pulmonary oedema was suspected, the volume of irrigated saline was checked. A total of 4000 of the total 9000 mL of the saline had been absorbed into intravascular compartment. She developed a severe metabolic acidosis (pH 7.09) with severe hypokalemia (K+ 2.3 mEq/L), hypocalcaemia (Ca2+ 0.76 mEq/L), anemia (hemoglobin 5.3 g/dL), and hypothermia (tympanic temperature 33°C), as well as a generalized oedema with pulmonary and airway oedema. Due to airway oedema, she could only be intubated with a 6.5-mm tracheal tube. Resuscitation in the ICU was required. Electrolyte disturbances were corrected and furosemide was administered. She had a full recovery after 24 hours and 48 hours later, she was discharged.
Absorption of the irrigation fluid can result in life-threatening fluid overload. Accurate fluid balancing and limiting the operation time may prevent such complications. Therefore, early diagnosis and treatment of this syndrome is emphasized.
Copyright © 2019, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
Imani F. Retraction Note: Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report. Anesth Pain Med. 2019;9(6):e100185. doi: https://doi.org/10.5812/aapm.100185
Imani F. Corrigendum to: Operative Hysteroscopy Intravascular Absorption Syndrome: The Gynaecology’s TURP Syndrome-A Case Report. Anesth Pain Med. 2019;9(6):e100184. doi: https://doi.org/10.5812/aapm.100184
TK KM, Kumar PV V. Retracted Article: Effect of Perioperative Intravenous Lignocaine Infusion on Haemodynamic Responses and postoperative Analgesia in Laparoscopic Cholecystectomy Surgeries. Anesth Pain Med. 2018;8(2):e63490. doi: https://doi.org/10.5812/aapm.63490
Mahrose R, Kasem AA. Pulse Pressure Variation-Based Intraoperative Fluid Management Versus Traditional Fluid Management for Colon Cancer Patients Undergoing Open Mass Resection and Anastomosis: A Randomized Controlled Trial. Anesth Pain Med. 2023;13(4):e135659. doi: https://doi.org/10.5812/aapm-135659
Kholdebarin A, Salehi R, Djalali Motlagh S, Fateh Boroumand M, Koleini ZS, et al. Effect of Intraoperative Hypertension on Postoperative Pain Severity After Abdominal Hysterectomy: A Randomized Controlled Trial. Zahedan J Res Med Sci. 2018;20(8):e64755. doi: https://doi.org/10.5812/zjrms.64755
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