[Carbon dioxide embolism during hysteroscopy followed by transient blindness].
A 43 year-old woman, with uterine bleeding and right ovary cyst, was scheduled for hysteroscopy-curettage and laparoscopy. Her history was unremarkable. After induction of general anaesthesia and tracheal intubation (propofol, fentanyl, vecuronium), anesthesia was maintained with N2O/O2 (60%/40%) and isoflurane 1 vol %. The patient was placed in the dorsal lithotomy position. Two minutes after the beginning of CO2 insufflation for hysteroscopy, a ventricular tachycardia with a circulatory arrest suddenly occurred. Insufflation was stopped, cardiopulmonary resuscitation started and lignocaine 100 mg iv administered. The haemodynamic status improved rapidly with a return to sinusal rhythm and stable blood pressure within two minutes. In the recovery room, the patient was restless and experienced blindness for 3 hours. Physical examination and all investigations (EEG, brain CT scan, carotid Doppler and transoesophageal echocardiography) were normal. The most probable diagnosis was a CO2 venous embolism associated with an arterial paradoxal embolism responsible for the temporary blindness.
Ghimouz
A
A
Département d'anesthésie et de réanimation, hôpital Lariboisière, Paris, France.
Loisel
B
B
Kheyar
M
M
Fried
D
D
Bouret
J M
JM
D000328:Adult; D001766:Blindness / Q000209:etiology*; D002245:Carbon Dioxide; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000379:methods; D017180:Tachycardia, Ventricular / Q000209:etiology
D002245:Carbon Dioxide
Embolie de CO2 lors d'une hystéroscopie suivie de cécité transitoire.