|COMMENTS ON PUBLISHED ARTICLE
|Year : 2015 | Volume
| Issue : 8 | Page : 531
Glycine induced retinotoxicity is avoidable
Choudhary Deepak, Sethi Priyanka, Sharma Vandana, Bhatia Pradeep Kumar
Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
|Date of Web Publication||17-Aug-2015|
Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Deepak C, Priyanka S, Vandana S, Kumar BP. Glycine induced retinotoxicity is avoidable. Indian J Anaesth 2015;59:531
We read the article 'glycine induced acute transient post-operative visual loss' by Pramod et al.  and agree with the authors that the absorption of large amount of glycine and application of higher than the recommended pressure were responsible for the glycine induced retinotoxicity.
The 'American Association of Gynecologic Laparoscopists' guidelines  for hysteroscopic surgery published in 2013 recommend avoidance of intrauterine distension pressure more than the patient's mean arterial pressure, and use of intra-cervical vasopressin (8 ml of 0.05 U/ml) to reduce the absorption of irrigation fluid.
Similar to transurethral resection of prostate (TURP) syndrome, use of neuraxial blockade in this case could have preserved consciousness of the patient and helped to detect the clinical features of volume overload and glycine toxicity at an earlier stage. , Patients undergoing TURP, hysteroscopy, or surgery in prone position should be informed pre-operatively about the possibility of post-operative temporary and permanent vision loss and such complaint by the patient in the post-operative period warrant urgent assessment and intervention.
Hence, we believe that use of neuraxial blockade, intra-cervical injection of vasopressin and adherence to the standard recommendations, could have avoided the complication.
| References|| |
Pramod A, Rajagopal S, Iyer VP, Murthy HS. Glycine induced acute transient postoperative visual loss. Indian J Anaesth 2015;59:318-9.
Munro MG, Storz K, Abbott JA, Falcone T, Jacobs VR, Muzii L, et al
. AAGL practice report: Practice guidelines for the management of hysteroscopic distending media. J Minim Invasive Gynecol 2013;20:137-48.
Mushambi MC, Williamson K. Anaesthetic considerations for hysteroscopic surgery. Best Pract Res Clin Anaesthesiol 2002;16:35-52.
Sethi N, Chaturvedi R, Kumar K. Operative hysteroscopy intravascular absorption syndrome: A bolt from the blue. Indian J Anaesth 2012;56:179-82.