title: Venous air embolism during total laparoscopic hysterectomy: comparison to total abdominal hysterectomy.
abstract: BACKGROUND
  Total laparoscopic hysterectomy (TLH) has become a widely accepted alternative to total abdominal hysterectomy (TAH). The aim of this study was to compare the incidence and grade of venous air embolism (VAE) in TLH to those in TAH using transesophageal echocardiography.
  
  
  METHODS
  Eighty-two American Society of Anesthesiologists physical status I patients scheduled for either TLH or TAH were enrolled. After induction of general anesthesia, a multiplane transesophageal echocardiography probe was inserted. The midesophageal four-chamber or bicaval view was continuously monitored. An independent transesophageal echocardiography-certified anesthesiologist graded VAE.
  
  
  RESULTS
  All patients undergoing TLH showed VAE, and 37.5% of patients had VAE grade higher than III. Fifteen percent of patients undergoing TAH showed VAE, and all of them were grade I. No patient in this study showed hemodynamic instability or electrocardiogram changes at the time of VAE occurrence. Most instances of VAE during TLH occurred during transection of the round ligament and dissection of the broad ligament.
  
  
  CONCLUSIONS
  The incidence of VAE in patients undergoing TLH was 100%. VAE grade in TLH was higher compared to that in TAH, especially during transection of the round ligament and dissection of the broad ligament. Although the hemodynamic instability associated with VAE during TLH was not observed in this study, anesthesiologists must be vigilant for detection of VAE during TLH.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chang Seok
authors.initials: CS
authors.lastname: Kim
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Kwon
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Sungwon
authors.initials: S
authors.lastname: Na
authors.forename: Jiwon
authors.initials: J
authors.lastname: An
authors.forename: Ki Jun
authors.initials: KJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D004618:Embolism, Air / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged