title: Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial.
abstract: OBJECTIVE
  The objective of the study was to determine the incidence and amount of gas embolism during hysteroscopic surgery using either monopolar or bipolar diathermia and to investigate the relationship between the severity of gas embolism and the amount of intravasation of distension fluid.
  
  
  METHODS
  This was a randomized, observer-blinded trial. Fifty patients, scheduled for hysteroscopic surgery, were assigned to either monopolar or bipolar diathermia. Transesophageal echocardiography was used to detect and classify gas embolism (grade 0-IV). Intravasation of distension fluid was measured.
  
  
  RESULTS
  Venous gas embolism was observed in all but 1 patient. A higher incidence of more extensive (grade IV) was seen during bipolar diathermia (42% vs 13%; P = .031). Paradoxical embolism was observed in 2 patients. When intravasation exceeded 1000 mL, significantly more grade IV venous gas embolism was seen (P = .049).
  
  
  CONCLUSIONS
  During hysteroscopic surgery, gas embolism was equally observed irrespective of the type of diathermia. However, more extensive embolism was observed when intravasation of distension fluid exceeded 1 L. These results question the acceptance of up to 2500 mL intravasation of distension fluid if bipolar diathermia is used.
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Birgitte A
authors.initials: BA
authors.lastname: Dyrbye
authors.forename: Lucilla E
authors.initials: LE
authors.lastname: Overdijk
authors.forename: Paul J
authors.initials: PJ
authors.lastname: van Kesteren
authors.forename: Peter
authors.initials: P
authors.lastname: de Haan
authors.forename: Robert K
authors.initials: RK
authors.lastname: Riezebos
authors.forename: Erica A
authors.initials: EA
authors.lastname: Bakkum
authors.forename: Bart M
authors.initials: BM
authors.lastname: Rademaker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003972:Diathermy / Q000009:adverse effects* / Q000379:methods; D004618:Embolism, Air / Q000209:etiology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects* / Q000379:methods; D007889:Leiomyoma / Q000601:surgery*; D008595:Menorrhagia / Q000601:surgery*; D008875:Middle Aged; D014594:Uterine Neoplasms / Q000601:surgery*