The etiology, frequency, and prevention of gas embolism during CO(2) hysteroscopy.
OBJECTIVE
To assess the frequency of clinically apparent and undetected cardiopulmonary emboli during diagnostic CO(2) hysteroscopy, to determine the causes of these events, and to define a risk profile.


METHODS
Retrospective and prospective case study (Canadian Task Force classification II-2).


METHODS
Obstetric-gynecologic clinic of an academic teaching hospital.


METHODS
Five thousand one hundred ninety-three women.


METHODS
Diagnostic CO(2) hysteroscopy performed between September 1990 and December 1998.


RESULTS
From September 1990 to December 1996, 1 (0.03%) severe but nonfatal embolism occurred in 3932 diagnostic CO(2) hysteroscopies. Undetected emboli were present in 20 patients (0.51%). Starting in January 1997 the gas supply tube (volume 40 ml) was deaerated before the procedures, and no emboli occurred in the next 1261 examinations up to December 1998. The decrease in frequency was statistically significant (p = 0.009). No pathologic flow sounds were found in any of 50 hysteroscopies monitored by Doppler stethoscope.


CONCLUSIONS
A manifest gas embolism is rare in diagnostic CO(2) hysteroscopy. The 10% to 50% frequency of undetected gas emboli cited by other authors could not be confirmed. If the supply tube system that holds room air is purged with CO(2) before the procedure, the already low risk drops to zero or almost zero, confirming the theory that emboli that occur during CO(2) hysteroscopy are caused by room air.
Brandner
P
P
Caritasklinik St. Theresia, Frauenklinik mit Neonatologie und Hebammenschule, Akademisches Lehrkrankenhaus der Universität des Saarlandes, Rheinstrasse 2, D-66113 Saarbrücken, Germany; fax 49 681 406 1383.
Neis
K J
KJ
Ehmer
C
C
D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000379:methods; D002245:Carbon Dioxide; D004618:Embolism, Air / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
D002245:Carbon Dioxide