Noncardiogenic pulmonary edema and venous air embolus as complications of operative hysteroscopy

Grove, Jerome J; Shinaman, Richard C; Drover, David R.

doi:10.1016/j.jclinane.2003.03.010

Cited by 45 publications

(30 citation statements)

References 16 publications

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“…The use of NS has been linked to hypervolemic syndrome; hyperchloremic metabolic acidosis and non cardiogenic pulmonary edema [4]. Cases have been reported of pulmonary embolism with the use of Ringer Lactate as distension fluid [5].…”

Section: Discussionmentioning

confidence: 99%

Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During Hysteroscopic Myomectomy: A Case Report

Nicora¹,

Suarez²,

Cubillos³

et al. 2014

JACCOA

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An otherwise healthy 44 year old woman (159 cm, 54 kg) was scheduled through day surgery regimen for a hysteroscopic Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During HysteroscopicMyomectomy: A Case Report AbstractBackground: Gynecological hysteroscopy is a relatively safe procedure, used for diagnosis and treatment of intrauterine pathologies with a low percentage of complications. Some complications may be life threatening.Case presentation: An otherwise healthy 44-year-old woman presented for hysteroscopic myomectomy under spinal anesthesia. A roller pump and a morcellator -type hysteroresectoscope were used along with normal saline as the distending solution with a perfusion pressure of 100 mmHg. Within 40 minutes, she complained of chest discomfort and presented tachypnea, tachycardia, hypertension and low oxygen saturation unresponsive to bag and mask ventilation with 100% oxygen. Massive facial edema developed rapidly. Orotracheal intubation was performed and pink frothy fluid came out of the ET. Fluid overload was suspected as the most likely diagnosis and the hysteroscopy was discontinued. Laboratory findings revealed severe respiratory acidosis and hypoxemia. She was treated aggressively with positive pressure ventilation, IV bicarbonate, diuretic and inotropic perfusions. A thorax x-ray confirmed the presence of massive pulmonary edema. After a highly negative fluid balance, the respiratory parameters improved very rapidly and she was extubated in the ICU 7 hours later Discussion: Fluid overload due to absorption of irrigation fluid is seen in approximately 0, 2% of patients. Hypervolemic syndrome and hyperchloremic metabolic acidosis have been reported in NS overload. In this case, a positive fluid balance of almost 6.5 l of NS was calculated; this was not identified before due to an error in the assembly of the circuit and bypass of the alarms thus leading to non-cardiogenic pulmonary edema, anasarca, respiratory acidosis, hypocalcaemia, coagulation and hemoglobin dilution, which resolved with forced diuresis and cardiopulmonary support. She was discharged after 7 days of the procedure. Conclusion

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Section: Discussionmentioning

confidence: 99%

Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During Hysteroscopic Myomectomy: A Case Report

Nicora¹,

Suarez²,

Cubillos³

et al. 2014

JACCOA

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“…Ancak, bunun aşırı sıvı yüklen-mesini önlese bile venöz hava embolisi riskini önleyemeyeceği bildirilmektedir. (6) Operatif histeroskopilerde görülen diğer bir komplikasyon hiponatremidir. Distansiyon sıvısı olarak % 5 mannitol kullanıl-masının sorbitol ve glisin kullanımına göre daha güvenli olduğu belirtilmekle birlikte bu sıvıların da hiponatremi ve aşırı sıvı yüklenmesi riski vardır.…”

Section: Discussionunclassified

“…Ringer laktat solusyonunun da glisin ve dekstran gibi solusyonların neden olduğu hiponatremi gibi komplikasyonları önleyebileceği bildirilse de bu tür cerrahi girişimler sırasında emilen sıvı miktarlarının hesaplanması gerektiği de vurgulanmaktadır. (6) Grove ve ark. (6) operatif histeroskopi için distansiyon sıvısı olarak Ringer laktat kullanılan 2 hastada, nonkardiyojenik akciğer ödemi ve venöz hava embolisi bildirmiştir.…”

Section: Discussionunclassified

“…(2)(3)(4) İşlem sırasında kullanılan distansiyon sıvılarının emilimi sonucu sıvı yüklenmesi ve buna bağlı akciğer ödemi, serebral ödem, konjestif kalp yetmezliği, elektrolit ve pıhtılaşma bozuklukları, kanama, gaz veya hava embolisi, litotomi pozisyonuna bağlı periferik nöropati gibi komplikasyonlarla karşılaşılabilmektedir. (1,2,6) Sıvı emilimi cerrahi girişim sırasında açılan damarlardan, endometriyum duvarı ya da tubalar yoluyla peritondan emilim şek-linde olabilir. (6) Endometriyum ve uterus kavitesinin görüntülenmesinde kullanılan elektrolit içermeyen sıvıların aşırı emilimi sonucu hiponatremi, hipopotasemi ve hipoosmolarite gelişebilir.…”

Section: Introductionunclassified

“…(1,2,6) Sıvı emilimi cerrahi girişim sırasında açılan damarlardan, endometriyum duvarı ya da tubalar yoluyla peritondan emilim şek-linde olabilir. (6) Endometriyum ve uterus kavitesinin görüntülenmesinde kullanılan elektrolit içermeyen sıvıların aşırı emilimi sonucu hiponatremi, hipopotasemi ve hipoosmolarite gelişebilir. (7,8) Histeroskopik girişimlerde komplikasyon gelişme oranı % 3-24, aşırı sıvı yüklenmesi veya hiponatremi gelişme oranı ise % 1-4 olarak bildirilmektedir.…”

Section: Introductionunclassified

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Noncardiogenic Pulmonary Edema, Hyponatremia and Venous Air Embolus in Operative Hysteroscopy: 2 Cases

Karaman¹,

Biricik²,

Günüşen³

et al. 2011

J Turk Anaesth Int Care

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ÖZETGünümüzde histeroskopi eşliğinde yapılan operasyonlar intrauterin patolojilerin tanı ve tedavilerinde yaygın olarak kullanılmaktadır. Histeroskopi, güvenli ve kısa süreli bir işlem olmasına rağmen, özellikle operatif histeroskopiler anestezistler açısından dikkat edilmesi gereken birçok riski de beraberinde taşımaktadır. Bu makalede, operatif histeroskopi uygulaması sırasında nonkardiyojenik pulmoner ödem, hiponatremi ve venöz hava embolisi gelişen 2 olgumuzu sunarak bu komplikasyonların yönetimine dikkat çekmeyi amaçladık.Anahtar kelimeler: Operatif histeroskopi, pulmoner ödem, hava embolisi, hiponatremi SUMMARY Noncardiogenic Pulmonary Edema, Hyponatremia and Venous Air Embolus in Operative Hysteroscopy: 2 CasesNowadays, hysteroscopy guided operations are widely used in the diagnosis and treatment of intrauterine pathologies. Although hysteroscopy is a safe and short procedure, particularly operative hysteroscopy brings along many risks that anesthetists should consider about. In this report, we presented two cases in which pulmonary edema, hyponatremia and venous air embolism developed during the operative hysteroscopy, and aimed to draw attention to the management of these complications.

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Good practice with fluid management in operative hysteroscopy

Vilos,

Abu‐Rafea

et al. 2024

Intl J Gynecology & Obste

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Hysteroscopic surgery requires a balance of continuous controlled irrigation and aspiration to distend the endometrial cavity to a degree that provides the clear and stable visual environment necessary for diagnostic and therapeutic procedures. Whereas the preferred distending solution should be isotonic and isonatremic, radiofrequency (RF) electrosurgery with monopolar instrumentation can only be performed with non‐ionic (hyponatremic) solutions. Absorption of as little as 500 mL and certainly more than 1000 mL of non‐ionic solutions can result in fluid overload and/or dilutional hyponatremia with potentially serious adverse effects under certain conditions and patient characteristics. Both hysteroscopic RF electrosurgery with bipolar instrumentation and electro‐mechanical morcellation and aspiration systems use isotonic and isonatremic solutions. Depending on the clinical context, absorption of more than 1500 mL of isonatremic solutions can also result in serious adverse effects. Automated fluid management systems are preferred and recommended, and surgeons should aim to maintain the maximum allowable intravasation of distending media below 1000 and 1500 mL for non‐ionic and ionic fluids, respectively.

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Noncardiogenic pulmonary edema and venous air embolus as complications of operative hysteroscopy

Cited by 45 publications

References 16 publications

Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During Hysteroscopic Myomectomy: A Case Report

Noncardiogenic Pulmonary Edema from Massive Irrigation Fluid Absorption During Hysteroscopic Myomectomy: A Case Report

Noncardiogenic Pulmonary Edema, Hyponatremia and Venous Air Embolus in Operative Hysteroscopy: 2 Cases

Good practice with fluid management in operative hysteroscopy

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