Gas Embolism During Hysteroscopic Surgery?

Abstract

During a period of 1 month, 3 episodes of probable or actual venous air embolism occurred during hysteroscopic surgery. All patients developed the same symptoms of ventilatory and hemodynamic decompensation, beginning with a reduction in end-tidal carbon dioxide, arterial desaturation, and cyanosis on the upper trunk, and rapidly progressed to hypotension and 2 cardiac arrests. While entrainment of some air is common during hysteroscopy, life-threatening embolism is a rare but serious complication for which an anesthetist needs to be vigilant and prepared. If even a small drop in end-tidal carbon dioxide occurs, venous air embolism should be suspected and the operation should be discontinued.

Complications in modern hysteroscopic myomectomy

“…Due to the fact that such a procedure must be repeated several times in case of multiple or large UFs, it raises the risk for complications, e.g. venous air embolism (VAE) [18,28]. Recently, a hysteroscopic morcellation system, somewhat similar to that used in laparoscopy, has been invented [8,23,27].…”

“…Ringer's solution or 0.9% saline solution are the most common fluids used as distension media in modern HM [8]. These media are isotonic and are applicable to bipolar methods, and they are also considered to be much safer than hypotonic media [8,18,22,28]. Gas media (e.g.…”

“…A venous air embolism (VAE) is one more type of complication which might occur during HM. The available literature describes the seriousness of the problem, allowing surgeons to learn how to deal with such cases [18,28]. An interesting study on VAE was published in Norway on the basis of three cases from their center [28].…”

“…VAE is a rare complication and the gas embolus may come from the medium used to expand the uterus during electrocoagulation or directly from the air in the operating room. The gas entering the cardiovascular system can cause arrhythmia, pulmonary hypertension, gas exchange disorders, and, in the worst-case scenario, can lead to death [28,39]. A patient who develops VAE will report chest pain, breathing disturbances, shortness of breath, or may cough [39].…”

“…A patient who develops VAE will report chest pain, breathing disturbances, shortness of breath, or may cough [39]. Some authors may find it unlikely, but asymptomatic gas in the right heart atrium after hysteroscopy is not a rare phenomenon [28,40]. More commonly used bipolar systems, which are less likely to cause OHIA, produce more air bubbles and increase the risk for VAE.…”