Carbon dioxide embolism during laser endometrial ablation

Abstract

SummaryA case of atypical headache presenting following otherwise unremarkable epidural analgesia in labour is presented. Although there was no suggestion of accidental dural puncture during insertion of the epidural catheter, and despite the unusual features of the headache and complicated case history, an epidural blood patch was performed 13 weeks post-partum, with improvement of the patient's symptoms. A repeat epidural blood patch 2 weeks later completely resolved her headache.

Air embolism during operative hysteroscopy: TEE-guided resuscitation

“…Although gas embolism during operative hysteroscopy has been described [7,[9][10][11][12][13][14][15][16][17][18][19], it seems that recognition of its importance has waned in the last decade with the advent of liquid distension medium. Nevertheless, the potential lethal impact of cardiovascular and neurological complications is still substantial during hysteroscopic surgery.…”

Gas embolism during VersaPoint hysteroscopic myomectomy

“…Gas embolism is an uncommon complication of operative hysteroscopy, particularly when aqueous fluid is used as the distension medium. However, it has been reported immediately following transcervical resection of the endometrium when the patient remained tilted head down 3 and during laser ablation with a sheathed coaxial gas‐cooled fibre Nd: YAG laser 4 . Known predisposing factors are forcible dilation of the cervix and Trendelenburg tilt, which allows opening of venous sinuses within the uterus and insufflation of air rather than carbon dioxide, which is rapidly absorbed into the blood 5–8 .…”

“…However, it has been reported immediately following transcervical resection of the endometrium when the patient remained tilted head down 3 and during laser ablation with a sheathed coaxial gas-cooled fibre Nd: YAG laser. 4 Known predisposing factors are forcible dilation of the cervix and Trendelenburg tilt, which allows opening of venous sinuses within the uterus and insufflation of air rather than carbon dioxide, which is rapidly absorbed into the blood. 5±8 In addition, excessively high pressure and flow rates when carbon dioxide is used as the distension medium are known to cause clinically significant embolism, when absorption and ventilation of CO 2 are insufficient to excrete all of the insufflated gas.…”