AANA journal
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Case Reports
Severe intraoperative hyponatremia in a patient scheduled for elective hysteroscopy: a case report.
Hysteroscopy is a minimally invasive procedure that may result in potentially disastrous complications. A hysteroscopy requires the insertion of a hysteroscope into the uterine cavity and the installation of a suitable distention medium for visualization of the endometrium. Potential risks include fluid volume overload, uterine perforation, hemorrhage, infection, and the need for immediate hysterectomy. ⋯ Hypotonic, electrolyte-free distention media have the potential to be absorbed in volumes large enough to cause hyponatremia and hypervolemia, complications initially described as transurethral resection of the prostate (TURP) syndrome. Hyponatremia and hypervolemia have been associated with hysteroscopic surgical procedures. The following is a case report detailing the perioperative events of a 40-year-old woman in whom severe hyponatremia developed during an elective hysteroscopy.
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A major responsibility of the nurse anesthetist is providing adequate pain relief. Current research suggests that provider gender, as well as patient gender, may affect the clinical assessment and treatment of pain. Implications of the undertreatment of pain may be avoided if the anesthetist is aware of potential gender bias when approaching a given clinical situation. ⋯ Significantly more male CRNAs (P < .05; chi 2) administered benzodiazepines along with the analgesic (21/74 [28%]) than did female CRNAs (11/59 [19%]); male CRNAs were more likely to administer benzodiazepines as part of their clinical management of cases involving males (13/38[34%]) than female patients (8/36 [22%]); however, this difference was not significant. Pain treatment strategies were indistinguishable between male and female anesthetists, as well as between male and female patients. However, gender-based differences in the use of sedation medication in concert with analgesic medication was an unexpected finding.