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How safe is the intravasation limit in hysteroscopic surgery?
B M P Rademaker1, P J M van Kesteren, P de Haan
1Department of Anesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. B.M.P.Rademaker@olvg.nl
Journal of Minimally Invasive Gynecology
|March 29, 2011
Summary
Transcervical resection of myomas (TCR-M) can cause gaseous embolism, indicated by physiological changes, especially with high fluid intravasation. Cardiovascular disturbances occurred frequently in patients undergoing TCR-M with significant fluid intake.
Area of Science:
- Gynecology
- Minimally Invasive Surgery
- Hysteroscopy
Background:
- Transcervical resection of myomas (TCR-M) is a common hysteroscopic procedure.
- Potential complications include gaseous embolism due to gas formation during myoma resection.
- The incidence of emboli during TCR-M is not well-established.
Purpose of the Study:
- To determine the occurrence of physiological changes indicating embolism during hysteroscopic myoma resection.
- To correlate these changes with the amount of fluid intravasation.
Main Methods:
- Retrospective analysis of anesthesia records and operation files for 234 patients.
- Patients underwent TCR-M using either monopolar or bipolar resectoscopes with specific distension fluids and intravasation limits.
- Patients were grouped based on fluid intravasation volume (≤500 mL, 500-1000 mL, 1000-1500 mL, 1500-2500 mL).
Main Results:
- Physiological changes indicative of gaseous embolism were observed in 33% to 43% of patients with 1000-2500 mL fluid intravasation.
- Nearly half of these patients experienced cardiovascular disturbances suggesting embolism formation.
Conclusions:
- Physiological changes attributable to gaseous embolism are frequent during TCR-M.
- Cardiovascular disturbances indicating gaseous embolism can occur even when fluid intravasation is limited according to current guidelines.
