VASCULAR UPTAKE OF HYSKON (DEXTRAN-70) DURING OPERATIVE AND DIAGNOSTIC HYSTEROSCOPY

The objective of this work was to determine whether the volume of Hyskon administered during operative and diagnostic hysteroscopy could be correlated with Hyskon blood levels in order to predict a threshold for toxicity and to investigate the action of Hyskon on the intrinsic clotting mechanism under controlled circumstances. Blood samples were collected in 20 women undergoing operative and diagnostic hysteroscopy before, during, and after surgery. Vascular uptake was assessed based on 30 min blood Hyskon levels, intrauterine pressure measurements, serum sodium levels, serum potassium levels, plasma coagulation factor changes, and relative degree of uterine wall injury. Hyskon blood levels at 30 min ranged from 0 mg % to 3400 mg %. The highest blood levels, 2900 mg %-3400 mg % were observed in cases where extensive uterine wall damage occurred. Instillation pressures at the operative sheath averaged 410 mm Hg, but intrauterine pressures for both operative and diagnostic hysteroscopy averaged 76 mm Hg. No significant changes in PT, PTT were observed. Plasma fibrinogen levels showed a mean diminution of 32.3 mg % (-3 to -93), however fibrin split products were not elevated. Serum sodium dropped between -2 and -9 mEq/L, with a mean diminution of 2.3 mEq/L. No patient in this study developed pulmonary edema, bleeding diathesis, or renal failure. The most critical factor relative to Hyskon circulatory uptake was the degree of damage caused to the endometrium and myometrium. There was poor correlation between volumes of injected Hyskon and 30 min blood levels.