The Impact of Anesthesia on the Absorption of Glycine in Operative Hysteroscopy: a Randomized Controlled Trial

• Median absorption of glycine (10th-90th centile) [ Time Frame: The absorption of glycine is measured between time of the introduction of the resectoscope and its final withdrawal. Assessed between 1 minute and 20 minutes after the end of surgery ] [ Designated as safety issue: No ]
  The primary outcome is the median absorption of glycine (10th-90th centile). The glycine absorption is measured by an automated surgical irrigator (tandem canister: Equimat and Endomat; Karl Storz Endoscopy, Tuttlingen, Germany) and it represent the difference between the input and the output of glycine used for the irrigation of the uterine cavity.
  
  

• Absorption of glycine greater than 1000 mL [ Time Frame: The absorption of glycine is measured between time of the introduction of the resectoscope and its final withdrawal. Assessed between 1 minute and 20 minutes after the end of surgery ] [ Designated as safety issue: No ]
  The total absorption of glycine is measured by an automated surgical irrigator (tandem canister: Equimat and Endomat; Karl Storz Endoscopy, Tuttlingen, Germany).
  
  
• Discontinuation of surgery because of excessive absorption. [ Time Frame: Assessed between 1 minute and 20 minutes after the end of surgery ] [ Designated as safety issue: No ]
  Left at the discretion of the surgeon and anesthesiologist. However, according to the guidelines of the ACOG and the AAGL, it is recommended to stop the surgery when the glycine deficit exceeds 1000-1500 mL. Therefore, the surgeon who is blinded to the absorption rate will be informed when it reachs 500 and 1000 mL.
  
  
• Difference of natremia pre and post-procedure [ Time Frame: Assessed the same day of surgery (no more than 6 hours after surgery) ] [ Designated as safety issue: No ]
  In the hour preceeding the surgery and in the hour following surgery, natremia will be measured in the patient serum.
  
  
• Postoperative severe hyponatremia [ Time Frame: Assessed the same day of surgery (no more than 6 hours after surgery) ] [ Designated as safety issue: No ]
  Defined as a patient's natremia below 125 meq/L in the first postoperative hour.
  
  
• Patient's satisfaction towards the type of anesthesia [ Time Frame: Assessed on postoperative day one. In average 24 hours after surgery. ] [ Designated as safety issue: No ]
  Patient's satisfaction toward their anesthesia was evaluated by the following yes or no question: "If you had to undergo the same surgery, would you choose the same type of anesthesia?".
  
  
• Quality of life and recovery [ Time Frame: Assessed on postoperative day one. In average 24 hours after surgery. ] [ Designated as safety issue: No ]
  8-item Short-Form Health Survey (SF-8) standardized questionnaire
  
  

As a minimally invasive procedure, operative hysteroscopy has gained popularity in the past two decades and became a standard surgical treatment for abnormal uterine bleeding unresponsive to medical management. Despite its increasing use, little information is known on the predictors of its potential complications. The absorption of glycine has been reported as the most common complication of this procedure and it remains an unpredictable complication that may lead to life-threatening conditions.

This randomized controlled trial is conducted in two centers: a tertiary care center and in a community hospital over a period of 18 months. This study aimed to compare two types of anesthesia on the absorption of glycine in operative hysteroscopy. Eligible patients undergoing operative hysteroscopy for abnormal uterine bleeding are randomized in two groups: group general anesthesia and group local anesthesia with sedation.