Cardiovascular Collapse during Gynecologic Endoscopy: Report of 2 cases / 대한마취과학회지

Hysteroscopy is an established gynecologic procedure that has been used for the past 20 years as a diagnostic technique. It is also used therapeutically. Hysteroscopy is commonly performed with CO2insufflation and its complications are rare. The sudden decrease of end-tidal partial pressure of carbon dioxide, associated with mill-wheel murmur, loss of cardiac output and sinus tachycardia on the ECG are highly suggestive of massive gas embolism during laparoscopy and hysteroscopy. We report 2 cases of cardiac arrest and severe bradycardia. The second patient's expired CO2 concentration fell rapidly to 7 mmHg and blood pressure and heart rate dropped suddenly after resection of the uterine septum and adhesiolysis. We performed cardiac resuscitation with cardiotonic drugs, cardiac compression, defibrillator and resulted in good recovery. At the time of discharge 10 days and 2 days later, the patients had recovered almost completely.

Gas Embolism during Diagnostic Laparoscopy Combined with Hysteroscopic Procedure: A case report / 대한마취과학회지

Laparoscopy is a frequently used technique in surgery and gaining wide popularity replacing laparotomy. The advantages of laparoscopy are shorter hospital stay, faster recovery, more decreased postoperative pain and smaller scar than laparotomy. But inducing artificial pneumoperitoneum with gas causes various complications. Among them, gas embolism is a rare but fatal complication and may occur more frequently when laparoscopy is performed simultaneously with hysteroscopy. We experienced one case of gas embolism during diagnostic laparoscopy for secondary infertility and hysteroscopic resection of uterine myoma under general anesthesia. Early diagnosis and prompt treatment seem to be the keys to prevent catastrophic outcome and the anesthesiologist should know about it's patho- physiology, preventive methods, diagnosis and treatment.