Prevention of air embolism during hysteroscopy

Abstract

Citation: Singh R, Sharma R, Jain A, Sinha S, Samra T. Prevention of air embolism during hysteroscopy (Correspondence). Anaesth Pain & Intensive Care 2014;18(4):469-70

Air embolism is a potentially catastrophic complication of operative hysteroscopy. Its incidence varies from 10-50% depending on the detection method used but prevalence of subclinical embolism may be as high as 100%.^1,2 We recently witnessed this complication in two patients and we briefly describe the preventive and therapeutic measures needed in such cases.

Twenty eight year old, ASA PS 1 female was scheduled for hysteroscopic guided Copper–T (Cu-T) removal. She underwent the same procedure previously, which was unsuccessful as only one limb of the Cu-T could be removed. Routine monitors were attached and anaesthesia was induced with IV propofol and fentanyl followed by insertion of No. 3 Proseal™ laryngeal mask airway. Anaesthesia was maintained with spontaneous breathing of oxygen (O₂), nitrous oxide (N₂O) and sevoflurane. The patient was placed in lithotomy position with 20⁰ Trendelenburg position. Hysteroscopy was performed using normal saline pressurized by pressure infuser on 3 lit non-collapsible bottle. Cu-T was firmly embedded in the myometrium and removed after vigorous extraction following which the patient developed pulseless electrical activity (PEA), with no recordable EtCO₂ and blood pressure. No heart sounds were heard but ECG showed sinus rhythm with heart rate of 90 bpm. Patient was immediately turned supine and administered 100% O₂ after trachea was intubated. Cardiopulmonary resuscitation was done for 45 min but patient could not be revived.