Phenylephrine-induced blood pressure elevation reduces pulmonary edema and distention fluid absorption in hysteroscopic myomectomy: a randomized controlled trial

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BACKGROUND: Hysteroscopic myomectomy is a common procedure for treating submucosal leiomyomas, but fluid overload and subsequent pulmonary edema are significant complications. This study investigates whether phenylephrine-induced increases in mean arterial pressure (MAP) can reduce pulmonary edema and distention fluid absorption in patients undergoing hysteroscopic myomectomy. MATERIAL AND METHODS: This randomized controlled trial enrolled 44 patients scheduled for hysteroscopic myomectomy. Patients were randomly assigned to receive either phenylephrine infusion to maintain MAP at 100-120% of the baseline value or normal saline infusion during surgery. The primary outcome was the incidence of pulmonary edema assessed by lung ultrasound (LUS). Secondary outcomes included B-line scores, thoracic fluid content (TFC), distention fluid deficit, use of furosemide, and so on. Receiver operating characteristic (ROC) curve analysis was performed in distention fluid deficit and ΔTFC to predict pulmonary edema. RESULTS: The phenylephrine group showed a significantly lower incidence of pulmonary edema [18.2 vs. 54.6%, RR = 0.33, 95% CI (0.13-0.81), P = 0.027] and lower LUS B-line scores [MD = -4.5, 95% CI (0-9), P = 0.016] compared to the control group. Additionally, the phenylephrine group had significantly reduced distention fluid deficit ( P = 0.018), lower TFC at the end of operation ( P = 0.008), and decreased use of furosemide ( P = 0.022). The best cutoff value in the diagnosis of pulmonary edema was 1900 ml for distention fluid deficit and 7.1/kΩ for ΔTFC, and areas under the ROC curves were 0.85, and 0.83, respectively. CONCLUSION: Phenylephrine administration during hysteroscopic myomectomy effectively reduces pulmonary edema and distention fluid absorption by increasing MAP. This study provides evidence for a new strategy in intraoperative fluid management for hysteroscopic surgeries.

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