Complications of fluid overload during hysteroscopic surgery

Hoffman, Christopher; Hal, Michele Van; Tariq, Rayhan; George, Shelley

doi:10.4097/kja.d.18.00374

Cited by 9 publications

(9 citation statements)

References 5 publications

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“…Use of continuous EtCO 2 has been recommended for hysteroscopy cases [4,5]. The authors have documented only desaturation, hemodynamic instability, hypercapnia (PaCO 2 of 49 mmHg) with no reference to EtCO 2 values, ECG changes, murmur, hypotension, or bradycardia at the time of the event [1]. The patient had bronchospasm, which can occur consequent to VAE and lead to increased peak airway pressures as noted in this case.…”

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confidence: 71%

“…The other arguments in favor of air embolism in the present case include the sudden catastrophic occurrence of hemodynamic instability with desaturation, lithotomy in the Trendelenburg position, probable spontaneous respiration during the event (positive pressure initiated after the event), and large uterine fibroids with the possibility of opening up the uterine sinuses. The patient had large uterine fibroids, and any uterine injury exposing large venous sinuses is the usual inciting factor of VAE [1]. Surgeons should maintain a close communication with anesthetists and inform the occurrence of even minor injuries.…”

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confidence: 99%

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Complications during hysteroscopy for gynecological procedures: prevention is better than cure!

Gupta

2020

Korean J Anesthesiol

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Hysteroscopy is the preferred method of diagnostic and therapeutic intervention for intrauterine pathologies. However, it may be associated with rare but serious complications such as venous air embolism (VAE), female transurethral resection of prostrate syndrome, fluid overload, uterine perforation, and hemorrhage. We read with great interest the article, "Complications of fluid overload during hysteroscopic surgery, " by Hoffman et al. [1]. We commend the authors for the prompt diagnosis and successful management of a relatively rare complication. However, we have few concerns and suggestions in this regard. Early signs of fluid overload in this case would be indicated by any measurable deficit in the input/output of the fluid used for distension and increase in venous pressures [2]. Mild pulmonary edema is reported with infusion of 800 ml of fluid under high pressure [3]. Two liters of isotonic normal saline used as the distention media in this case can surely lead to volume overload. However, the authors did not report the uterine distension pressure and difference in the volumes of the returning and purged fluids, which is important in cases of fluid overload and VAE [1]. The authors used laryngeal mask airway (LMA) for the prolonged surgery in the lithotomy and Trendelenburg positions, considering the possibility of fluid overload. However, the position recommended in these cases is supine/reverse Trendelenburg, and endotracheal intubation with positive-pressure ventilation should be performed [4,5]. In addition, the airway seal pressure at the time of insertion and during the event are not mentioned. The possibility of LMA displacement or laryngeal edema that can lead to inadequate ventilation cannot be ruled out. The Trendelenburg position causes negative pressure in the pelvic veins and increases the risk of VAE, especially in spontaneously breathing patients. Positive pressure ventilation was not mentioned in the report prior to the event; thus, we can assume that both the conditions were prevailing, thereby increasing the risk of VAE in this patient. Desaturation and hemodynamic instability occurred in the present case 150 minutes after induction, and the possibility of a VAE cannot be ruled out. Hysteroscopy-related VAE is a relatively common occurrence, with a high reported incidence of 10-50% [5]. However, most of such VAE events are clinically insignificant, as the liver might be acting as a filter reducing the amount of air reaching the pulmonary circulation. The characteristic clinical features include decreased end-tidal carbon dioxide (EtCO 2) concentration, desaturation, bradycardia, tachycardia, "mill wheel" murmur, bronchospasm, and respiratory and cardiac arrest [4,5]. Other characteristic clinical features include increased pulmonary arterial and central venous pressures, decreased blood pressure, electrocardiogram (ECG) changes, decreased arterial partial pressure of oxygen, and a widened gap

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confidence: 71%

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confidence: 99%

Complications during hysteroscopy for gynecological procedures: prevention is better than cure!

Gupta

2020

Korean J Anesthesiol

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“…However, operative hysteroscopy may be associated with complications such as uid overload, uterine perforation, and bleeding [8]. Several strategies have been used to facilitate the procedure and improve prognosis [9][10][11]. There is evidence on using gonadotropin agonists [12,13] and letrozole [14] as a preoperative intervention.…”

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confidence: 99%

Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial

Sayyah-Melli

Shishavan

Behravan

et al. 2020

Preprint

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Background: Concurrent bleeding or existing clots usually obscure the vision field and decrease the success rate of hysteroscopy. Therefore, any efforts made in order to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. We examined the effect of preoperative clot evacuation on hysteroscopy and patient outcomes. Methods: In this parallel-group trial, 114 patients with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or standard hysteroscopy alone. The investigated endpoints were the clarity of vision, amount of bleeding, the volume of distension media, duration of the procedure, and postoperative complications. Results: All 114 participants completed the study. There were statistically significant differences in the frequency of the clear vision (p<.001), the severity of bleeding (p=.0006), mean procedure time (p<.001), mean serum volume used (p<.001), and the postoperative hematocrit levels (p<.001) between groups, in favor of women with preprocedural intrauterine evacuation. There was no difference related to in-hospital stay (p=0.081) and anesthetic complications among the patients (p=0.182). The procedure was successfully performed on all patients of both groups with zero postoperative complications. Conclusion: Removal of clots and other uterine contents before the insertion of the hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities. This additional surgical step could take a significant impact on surgical and clinical outcomes. Trial registration: Clinical trial registry name: Iranian Registry of Clinical Trials Url: https://en.irct.ir/trial/33369 The registration number: IRCT20101130005283N13 Date of trial registration: 2018-11-16

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“…However, operative hysteroscopy may be associated with some complications such as fluid overload, bleeding, and uterine perforation [8]. Several strategies have been used to facilitate the procedure and improve the prognosis [9][10][11]. There is evidence on using gonadotropin agonists [12,13] and letrozole [14] as a preoperative intervention.…”

Section: Introductionmentioning

confidence: 99%

Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial

Sayyah-Melli

Shishavan

Behravan

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Concurrent bleeding or existing clots usually obscure the vision field and decrease the hysteroscopy success rate. Therefore, any efforts made to have a clear view during the hysteroscopy will improve the diagnostic or treatment outcomes. In this study, we examined the effect of preoperative clot evacuation on hysteroscopy and patient outcomes.Methods: In this parallel-group clinical trial conducted from December 2018 to September 2019 at the Oncology Center of Alzahra Teaching Hospital in Tabriz, Iran, 114 patients with uterine bleeding were randomly assigned to receive either clot evacuation before standard operative hysteroscopy or standard hysteroscopy alone. The investigated endpoints were the clarity of vision, the volume of used distension media, duration of the procedure, amount of bleeding, and postoperative complications.Results: All 114 participants completed the study. There were statistically significant differences in the frequency of the clear vision (p<.001), the severity of bleeding (p=.0006), mean serum volume used (p<.001), mean procedure time (p<.001), and the postoperative hematocrit levels (p<.001) between groups, in favor of women with preprocedural intrauterine evacuation. There was no difference in in-hospital stay (p=0.081) and anesthetic complications among the patients (p=0.182). The procedure was successfully performed on all patients of both groups with zero postoperative complications.Conclusion: Removal of clots and other uterine contents before inserting hysteroscope rendered better and faster access to the uterine wall to observe existing abnormalities and reduce the hysteroscopy time. This additional surgical step could take a significant impact on surgical and clinical outcomes.Trial registration: Clinical trial registry name: Iranian Registry of Clinical Trials URL: https://en.irct.ir/trial/33369 The registration number: IRCT20101130005283N13 Date of trial registration: 2018-11-16

show abstract

Complications of fluid overload during hysteroscopic surgery

Cited by 9 publications

References 5 publications

Complications during hysteroscopy for gynecological procedures: prevention is better than cure!

Complications during hysteroscopy for gynecological procedures: prevention is better than cure!

Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial

Uterine Evacuation before Operative Hysteroscopy in Patients with Active Uterine Bleeding: A randomized controlled trial

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