Monitoring of Gas Emboli During Hysteroscopic Surgery: A Prospective Study.
OBJECTIVE
Previous studies have demonstrated a high frequency of gas emboli during hysteroscopy, but guidelines for the prevention, early detection, and intervention of gas embolism during hysteroscopic procedures are still lacking. This study aimed to gain a clearer understanding of risk factors and specific signs and symptoms associated with gas emboli.


METHODS
This prospective study enrolled 120 women scheduled for hysteroscopy using 5% glucose as distension medium. The gas bubbles were monitored sequentially in internal iliac vein, common iliac vein, inferior vena cava, superior vena cava, heart, and pulmonary artery under the gray-scale imaging of Doppler ultrasound. The frequency, extent, and the hemodynamic and respiratory effects of gas emboli were evaluated. The interventions and outcomes were recorded. The risk factors associated with gas emboli, and their relationship with the frequency and extent of gas emboli, were assessed.


RESULTS
In our study, evidence of gas emboli under Doppler ultrasound monitoring was observed in 44 (36.7%) patients. The operation was continued and finished as soon as possible for patients presenting with stable vital signs or transient hemodynamic and respiratory changes, which resolved spontaneously without intervention. The operation was paused for patients presenting with significant hemodynamic changes or loss of consciousness, and the operation was resumed shortly after resumption of stable vital signs following symptomatic treatment. All patients in our study finished the operation and recovered without developing serious complications. Data analysis showed prolonged procedure duration and increased bleeding volume were both positively correlated with the frequency and extent of gas emboli.


CONCLUSIONS
Our study demonstrated a high frequency of gas emboli during hysteroscopy. Doppler ultrasonic monitoring combined with a clearer understanding of specific signs, symptoms, and risk factors will facilitate early detection and intervention of gas emboli during hysteroscopy.
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Sheng-Qun
SQ
Liu
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Su-Zhen
SZ
Zhao
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Zhan-Wen
ZW
Li
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Su-Ping
SP
Lv
Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Yue-Qiang
YQ
Liu
Experimental Medicine , Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China.
Yi
Y
Li
D000328:Adult; D000368:Aged; D004618:Embolism, Air / Q000000981:diagnostic imaging*; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007084:Iliac Vein / Q000000981:diagnostic imaging; D008875:Middle Aged; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler / Q000379:methods*; D014684:Venae Cavae / Q000000981:diagnostic imaging; D055815:Young Adult
gas emboli; hysteroscopy; monitoring; risk factors