Venous Air Embolism During Hysteroscopic Myomectomy: A Case Report and Evidence Based-Management

Abstract

media (excessive absorption of liquid or gas), thermal and/or mechanical injuries, or a combination of all of them. During hysteroscopic surgery, there is a potential risk for air or gas to entery the circulation through exposed uterine veins. Large open venous sinuses allow entry of air or gas into the right side of the heart and pulmonary system, especially when there is a favorable pressure gradient created by the Trendelenburg position of the patient and/or the intrauterine distension due to the fluid. Therefore, pulmonary gas embolism is a known complication during operative hysteroscopy that may have significant consequences (3,4). The gas entering ABSTRACT Operative hysteroscopic procedures can be performed safely in the outside the operating room. During hysteroscopic surgery, there is a potential risk for air or gas to enter the circulation from exposed uterine veins. Therefore, pulmonary gas embolism is a complication during operative hysteroscopy that can have significant consequences. In this case report, we wanted to talk about air/gas embolism that developed during hysteroscopy. A 21-year-old, 160 cm, 61 kg patient underwent hysteroscopic myomectomy. At the 70 th minute of surgery, ETCO 2 suddenly dropped from 35 mmHg to 15 mmHg, and SpO 2 regressed to 93%. Transesophageal echocardiography revealed enlargement of the right atrium and severe stretching of the right atrial septum. The patient, whose hemodynamics improved after fluid resuscitation and cardiac supportive treatment, was extubated at the end of the operation. Avoiding excessive Trendelenburg position, selection of irrigation fluid and pressure control, surgical technique and surgical time, selection of cauterization, awareness of the anesthesia team, and rapid response time play critical roles in the management of venous air or gas embolism.