Probable gas embolism during operative hysteroscopy caused by products of combustion

Abstract

With all the precautions in place to minimize the likelihood of fluid overload and ambient air embolism occurring, we surmised that products of combustion were the cause of the gas embolism. During endometrial ablation, gaseous products of combustion, mainly carbon dioxide, accumulate. The gases may then contribute to the rise in uterine pressure that occurs as irrigation fluid enters the uterus and this rise in pressure in turn encourages passage of gas into the open venous sinuses.

BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy

“…To minimise the risk of air embolism, the hysteroscope and inflow tubing should be primed with the fluid media to eliminate air bubbles before inserting the hysteroscope into the uterine cavity [37]. Gas embolism may arise from the combustion of gases produced during hysteroscopic electrosurgery [40]. The gases normally produced are primarily carbon dioxide (CO 2 ) as well as carbon monoxide and evaporative gases, the latter being easily soluble in blood and hence do not cause serious complications [40].…”

Air embolism during operative hysteroscopy: TEE-guided resuscitation

“…Although gas embolism during operative hysteroscopy has been described [7,[9][10][11][12][13][14][15][16][17][18][19], it seems that recognition of its importance has waned in the last decade with the advent of liquid distension medium. Nevertheless, the potential lethal impact of cardiovascular and neurological complications is still substantial during hysteroscopic surgery.…”

Fatal Venous Air Embolism After Hysteroscopy

“…Histeroskopi sırasında gelişen pulmoner emboli nadir, ancak mortaliteye neden olabilen bir komplikasyondur (7) . Pulmoner emboli, venöz trombüs, amnion sıvısı, yağ, tümör dokusu, karbondioksit ve hava gibi farklı nedenlere bağlı olarak gelişebilir (8) .…”