Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility (Drs. G. A. Vilos, Hutson, Giannakopoulos, Rafea, and A. G. Vilos).
Department of Obstetrics and Gynecology, Divisions of Reproductive Endocrinology and Infertility (Drs. G. A. Vilos, Hutson, Giannakopoulos, Rafea, and A. G. Vilos).
J Minim Invasive Gynecol. 2020 Mar-Apr;27(3):748-754. doi: 10.1016/j.jmig.2019.05.003. Epub 2019 May 14.
To highlight the circumstances, presentation, and treatment of venous gas embolism (VGE) and provide guidance and propose potential changes in surgical practice and perioperative monitoring to minimize the adverse consequences and sequalae of this potentially serious complication.
A case series.
A university-affiliated teaching hospital.
Five women developed VGE during hysteroscopic endometrial ablation.
From 1990 through 2014, the principle author (G.A.V.) performed 5249 primary and 458 repeat hysteroscopic endometrial ablations under general anesthesia using a monopolar 26F (9-mm) resectoscope connected to a peristaltic pump-driven active inflow and outflow irrigation and distension system (1.5% glycine) and an 8-mm monopolar loop electrode at a 120-W continuous (cut) and/or a 3- to 5-mm rollerball interrupted (coagulation) waveform or a combination of them.
Among 5707 procedures, we encountered 5 (0.09%, 1/1140) incidents of VGE during primary ablations. All patients exhibited the same symptoms of ventilatory and hemodynamic decompensation, beginning with a reduction in end-tidal carbon dioxide and arterial oxygen desaturation. All patients recovered after immediate cessation of the surgery and resuscitation including ventilatory support with 100% O and intravenous fluids.
Although entrainment of some air/gas bubbles is common during hysteroscopy, life-threatening/fatal VGE is rare (1/1140 cases). Situational awareness and strict adherence to certain principles including understanding the conditions, prerequisites, and pathophysiology of VGE; attention to surgical principles and operative technique; close communication with the anesthesiologist; and early therapeutic intervention are of paramount importance to avoid this rare but potentially serious complication.
强调静脉气体栓塞（VGE）的情况、表现和治疗，并提供指导和提出潜在的手术实践和围手术期监测的变化，以最大限度地减少这种潜在严重并发症的不良后果和后遗症。
病例系列。
一所大学附属医院。
五名女性在宫腔镜子宫内膜消融术中发生 VGE。
从 1990 年到 2014 年，主要作者（G.A.V.）在全身麻醉下使用单极 26F（9 毫米）切除镜进行了 5249 例原发性和 458 例重复宫腔镜子宫内膜消融术，该切除镜连接到蠕动泵驱动的主动流入和流出冲洗和扩张系统（1.5%甘氨酸）和 8 毫米单极环电极，以 120-W 连续（切割）和/或 3 至 5-mm 滚球间断（凝固）波形或它们的组合。
在 5707 例手术中，我们在原发性消融术中遇到了 5 例（0.09%，1/1140）VGE 事件。所有患者均出现相同的呼吸和血流动力学失代偿症状，表现为呼气末二氧化碳减少和动脉血氧饱和度降低。所有患者在立即停止手术和复苏后均恢复，包括使用 100%O2 和静脉输液进行通气支持。
尽管在宫腔镜检查中经常会混入一些空气/气泡，但危及生命/致命的 VGE 很少见（1/1140 例）。情况意识和严格遵守某些原则至关重要，包括了解 VGE 的条件、前提条件和病理生理学；关注手术原则和手术技术；与麻醉师密切沟通；以及早期治疗干预，以避免这种罕见但潜在严重的并发症。
