Gas embolism during hysteroscopy

Abstract

Purpose: Gas embolism during hysteroscopy is rare but sometimes fatal. A fatal case of gas embolism during diagnostic hysteroscopy using carbon dioxide (CO2) is presented. Clinical features: A 68 yr old woman was admitted for treatment of myoma and cancer of the uterus. Hysteroscopy using CO2 was performed without monitoring or anesthesia on the ward. At the end of the examination, just after the hysteroscope was removed, she developed tonic convulsions, lost consciousness, and her pulse was impalpable. Cardiac massage was started, anesthesiologists were called and the trachea was intubated. She was transferred to the intensive care unit with continuous cardiac massage. Cardiac resuscitation was successful. A central venous line was inserted into the right ventricle under echocardiography in an attempt to aspirate gas with the patient in the Trendelenberg position, but the aspiration failed. Positive end expiratory pressure and heparin for emboli, midazolam for brain protection, and catecholamines were administered. Fifteen hours after resuscitation, the pupils were enlarged and she died 25 hr after resuscitation. Conclusion: Gas embolism is a rare complication of hysteroscopy. The procedure should be performed with monitoring of blood pressure, heart rate, oxygen saturation and end-tidal CO2 concentration.