Inhalation anesthesia with methoxyflurane for office hysteroscopy

Abstract

Hysteroscopy is considered the “gold standard” for endoscopic visualization of the uterine cavity. Various methods of anesthesia and analgesia for the hysteroscopy procedure are described, including general anesthesia, sedation, local anesthesia, oral analgesics, and inhalation anesthesia.The objective: to assess the use of inhalation sedation with methoxyflurane during office hysteroscopy.Materials and methods. A prospective clinical study was performed in 109 patients during 2022-2024 who admitted to the reproductive health center “Damia” for the treatment of infertility. During office hysteroscopy, all patients had examination of the uterine cavity and biopsy of the endometrium with forceps.I group included 57 women who were prescribed rectal ketoprofen 100 mg and per os paracetamol 500 mg as analgesia during hysteroscopy in outpatient settings; II group involved 52 patients who received methoxyflurane for analgesia through an individual device for inhalation use.The Spielberger–Hanin scale was used to determine the levels of personal and reactive anxiety; assessment of psychoemotional status for the study of depressive disorders was carried out using the Beck depression scale and determination of the effectiveness of analgesic therapy. Statistical processing of the research results was performed using the program “STATISTICA 10”.Results. The spread of chronic endometritis, which was diagnosed for the first time, was established in more than half of the patients (56.9%). When using methoxyflurane for analgesia by the inhalation method, the examined patients subjectively assessed the pain at a rather low level (0.14±0.05 points), and the intensity of pain in the I group was significantly higher (0.41±0.08 points; p=0.005).In the postoperative period in the patients of the I group there were significantly higher levels of depressive disorders (7.84±0.86 points vs 4.54±0.62 points in the II group; p=0.002), personal (27.12±2.32 points vs 19.64±2.04 points; p=0.017) and situational (21.92±2.14 vs 15.56±1.72 points; p=0.022) anxiety, a reduced level of mood and emotionality, which differed from the indicators of women of the II group. Among the most frequent complaints in the I group, dyspeptic disorders (31.6%) and pain in the epigastric area (21.05%) were observed. When using methoxyflurane, the most frequent complaints were headache and drowsiness (11.5% each).Conclusions. The use of inhalation anesthesia with methoxyflurane during hysteroscopy allows to reduce negative pain sensations, anxiety and can be the optimal method for anesthesia for its performance in outpatient conditions.