Canadian Journal of Anesthesia

, Volume 49, Issue 10, pp 1044–1047 | Cite as

Probable gas embolism during operative hysteroscopy caused by products of combustion

  • Ngozi Imasogie
  • Ron Crago
  • Nicholas A. Leyland
  • Frances Chung
General Anesthesia

Abstract

Purpose

Gas embolism is a rare but well documented entity during operative hysteroscopy, with an incidence of 10–50%. Catastrophic outcomes occur at a rate of three in 17,000 procedures. The purpose of this report is to present a non-fatal case of gas embolism probably caused by the gaseous products of combustion.

Clinical features

A 50-yr-old woman with a history of menorrhagia was scheduled for hysteroscopy and endometrial ablation and polypectomy. Fifteen minutes into the procedure, with the patient in lithotomy position, 20° head down tilt, and breathing spontaneously, a sudden oxygen desaturation occurred from 97% to 87%. The patient’s end-tidal carbon dioxide dropped from 46 mmHg to 27 mmHg. The patient’s breathing pattern remained normal, respiratory rate remained 11–12 breaths·min−1 but amplitude of the reservoir bag movement was increased. Cardiovascular variables remained stable. She responded rapidly to 100% oxygen and made an uneventful recovery. Having ruled out other possible causes, we concluded gas embolism was responsible for the fall in oxygen saturation and end-tidal CO2.

Conclusion

With all the precautions in place to minimize the likelihood of fluid overload and ambient air embolism occurring, we surmised that products of combustion were the cause of the gas embolism. During endometrial ablation, gaseous products of combustion, mainly carbon dioxide, accumulate. The gases may then contribute to the rise in uterine pressure that occurs as irrigation fluid enters the uterus and this rise in pressure in turn encourages passage of gas into the open venous sinuses.

Keywords

Desflurane Anaesth Intensive Endometrial Ablation Toronto Western Hospital Operative Hysteroscopy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Probabilité d’embolie gazeuse causée par des produits de combustion pendant l’hystéroscopie peropératoire

Résumé

Objectif

L’embolie gazeuse est un état pathologique rare, mais bien documentée, survenant pendant l’hystéroscopie peropératoire selon une incidence de 10– 50%. Des conséquences catastrophiques surviennent dans trois interventions sur 17 000. Nous avons voulu présenter un cas d’embolie gazeuse non mortelle causée probablement par des produits de combustion gazeux.

Éléments cliniques

Une femme de 50 ans présentant des antécédents de ménorragie devait subir une hystéroscopie et l’ablation de l’endomètre ainsi qu’une polypectomie. Quinze minutes après le début de l’opération, la patiente en position de lithotomie, avec inclinaison de 20° et tête vers le bas, respirait spontanément quand est survenue une soudaine désaturation en oxygène qui est passé de 97% à 87%. Le gaz carbonique télé-expiratoire du patient a chuté de 46 mmHg à 27 mmHg. Le type de respiration est demeuré normal, le rythme respiratoire était de 11–12 respirations·min−1, mais l’amplitude du mouvement du sac-réservoir a augmenté. Les variables cardiovasculaires étaient stables. La patiente a réagi rapidement à l’administration de 100% d’oxygène et s’est bien rétablie. Après avoir exclu d’autres causes possibles, nous avons conclu qu’une embolie gazeuse avait causé la chute de saturation en oxygène et le CO2 télé-expiratoire.

Conclusion

Considérant toutes les précautions mises en place pour minimiser la probabilité d’une surcharge liquide et d’une embolie à l’air ambiant, nous avons supposé que les produits de combustion étaient la cause de l’embolie gazeuse. Pendant l’ablation de l’endomètre, des produits de combustion gazeux, surtout du gaz carbonique, s’accumulent. Les gaz peuvent ainsi contribuer à l’élévation de la pression utérine qui survient au moment où le liquide d’irrigation pénètre dans l’utérus. Cette hausse de pression favorise le passage de gaz dans les sinus veineux.

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Copyright information

© Canadian Anesthesiologists 2002

Authors and Affiliations

  • Ngozi Imasogie
    • 1
  • Ron Crago
    • 1
  • Nicholas A. Leyland
    • 1
  • Frances Chung
    • 1
  1. 1.Department of Anesthesia, Toronto Western Hospital, University Health NetworkUniversity of TorontoTorontoCanada

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