[Complications of hysteroscopical myomectomy: a report of two cases].
Hysteroscopical myomectomy has recently become popular in Japan. We present two patients who developed water intoxication and air embolism during surgery. [Case 1] Hysteroscopical myomectomy was performed under general anesthesia in a 37-yr-old woman (ASA I). Three hours after the start of the surgery, the patient's serum sodium concentration dropped to 118 mEq.l-1. She was treated with furosemide and recovered without sequelae. [Case 2] A 39-yr-old woman (ASA I) was scheduled to have hysteroscopical myomectomy under spinal and epidural anesthesia. Forty-five minutes after the start of the surgery, the patient complained of severe back pain, her blood pressure decreasing to 40 mmHg, SpO2 decreased to 80%, and ECG showed atrial fibrillation. After administration of ephedrine 5 mg, she recovered within 20 min. No abnormality was observed in echocardiogram, although some negative spots were detectable in a lung scintigraphy. She was discharged without sequelae. The hysteroscopical procedure is considered a non-invasive surgery, but the cases presented here emphasize the necessity for close attention to complications, especially pulmonary embolism.
Fukuda
T
T
Department of Anesthesiology, Tsukuba University.
Fujii
T
T
Saito
S
S
Nishida
M
M
Toyooka
H
H
D000328:Adult; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D007889:Leiomyoma / Q000601:surgery*; D011655:Pulmonary Embolism / Q000209:etiology*; D014594:Uterine Neoplasms / Q000601:surgery*; D014869:Water Intoxication / Q000209:etiology*