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[Air embolism and exploratory hysteroscopy: myths or realities? Preliminary results]
F Pierre1, J Lansac, J H Soutoul
1Département de Gynécologie-Obstétrique, CHU de Tours.
Objective:
Authors tried to evaluate the prevalence of air embolism which is a severe complication of carbon dioxide hysteroscopy.
Design:
On one hand, a retrospective inquiry with 18 hyperbaric oxygen therapy units over a 8 year period (1985 to 1992 included); and on the other hand, a prospective study with monthly survey to 84 public Gynaecology units during a 2 year period (January 1991 the 1st to December 1992 the 31st).
Results:
From the 18 hyperbaric oxygen therapy units receiving iatrogenic air embolism, gynaecologic endoscopy represent 20% of the patients. Among these, 2/3 come from laparoscopy and 1/3 from hysteroscopy. In the prospective study, 42 public Gynaecology units made 5,140 carbon dioxide hysteroscopies. Three air embolism were declared in this population (i.e. 0.58/1000) with 1 death and 2 recoveries without sequelae after hyperbaric oxygen therapy.
Conclusion:
Analysis of these cases suggest that, for this risk, one should oppose ambulatory hysteroscopy without anaesthesia to hysteroscopy under general anaesthesia with frequent cervical dilatation, prolonged duration and different underlying pathology.