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Amirkhanloo F, Haddadi M, Ebrahimi M. Paradoxical air embolism in patients undergoing hysteroscopic surgery for cesarean scar pregnancy: A case report and review of the literatures. Clin Case Rep 2024; 12:e9060. [PMID: 38947538 PMCID: PMC11211086 DOI: 10.1002/ccr3.9060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/10/2024] [Accepted: 05/28/2024] [Indexed: 07/02/2024] Open
Abstract
Cesarean scar pregnancy cases who undergo hysteroscopic suction aspiration could be at higher risk of air emboli due to dilated, low-resistant, high-velocity blood vessels.
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Affiliation(s)
- Fatemeh Amirkhanloo
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
| | - Mohammad Haddadi
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
| | - Mahbod Ebrahimi
- IVF Unit, Obstetrics and Gynecology WardYas Hospital Complex, Tehran University of Medical SciencesTehranIran
- Vali‐E‐Asr Reproductive Health Research Center, Family Health Research InstituteTehran University of Medical SciencesTehranIran
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Wang D, Dai W, Tang D, Liang Y, Ouyang J, Wang H, Peng Y. Deep learning approach for bubble segmentation from hysteroscopic images. Med Biol Eng Comput 2022; 60:1613-1626. [DOI: 10.1007/s11517-022-02562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 03/25/2022] [Indexed: 11/30/2022]
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Vitale SG, Watrowski R, Barra F, D’Alterio MN, Carugno J, Sathyapalan T, Kahramanoglu I, Reyes-Muñoz E, Lin LT, Urman B, Ferrero S, Angioni S. Abnormal Uterine Bleeding in Perimenopausal Women: The Role of Hysteroscopy and Its Impact on Quality of Life and Sexuality. Diagnostics (Basel) 2022; 12:diagnostics12051176. [PMID: 35626331 PMCID: PMC9140476 DOI: 10.3390/diagnostics12051176] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Abnormal uterine bleeding (AUB) is a frequent symptom in perimenopausal women. It is defined as uterine bleeding in which the duration, frequency, or amount of bleeding is considered excessive and negatively affects the woman’s quality of life (QoL) and psychological well-being. In cases of structural uterine pathology, hysterectomy (usually performed via a minimally invasive approach) offers definitive symptom relief and is associated with long-lasting improvement of QoL and sexuality. However, over the past 30 years, uterus-preserving treatments have been introduced as alternatives to hysterectomy. Hysteroscopic polypectomy, myomectomy, or endometrial resection/endometrial ablation are minimally invasive techniques that can be used as an alternative to hysterectomy to treat AUB due to benign conditions. Although associated with high patient satisfaction and short-term improvement in their QoL, hysteroscopic treatments do not eliminate the risk of AUB recurrence or the need for further intervention. Therefore, considering the impact of different treatment options on QoL and sexuality during preoperative shared decision making could help identify the most appropriate and personalized treatment options for perimenopausal women suffering from AUB.
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Affiliation(s)
- Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
- Correspondence: (S.G.V.); (R.W.)
| | - Rafał Watrowski
- Faculty of Medicine (Associate), University of Freiburg, 79106 Freiburg, Germany
- Correspondence: (S.G.V.); (R.W.)
| | - Fabio Barra
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Maurizio Nicola D’Alterio
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL 33146, USA;
| | - Thozhukat Sathyapalan
- Academic Diabetes, Endocrinology and Metabolism, Hull York Medical School, University of Hull, Kingston upon Hull HU6 7RX, UK;
| | - Ilker Kahramanoglu
- Department of Gynecologic Oncology, Emsey Hospital, 34912 Istanbul, Turkey;
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología, Mexico City 11000, Mexico;
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd., Zuoying Dist, Kaohsiung City 81362, Taiwan;
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, No. 155, Sec. 2, Li-Nong Street, Pei-Tou, Taipei 11265, Taiwan
- Department of Biological Science, National Sun Yat-sen University, 70 Lienhai Rd., Kaohsiung City 80424, Taiwan
| | - Bulent Urman
- Centre for Reproductive Endocrinology and Infertility, American Hospital, 34365 Istanbul, Turkey;
- Department of Obstetrics and Gynecology, Reproductive Endocrinology, Infertility Centre Istanbul, Koc University, 34450 Istanbul, Turkey
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, University of Genova, 16132 Genoa, Italy; (F.B.); (S.F.)
| | - Stefano Angioni
- Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy; (M.N.D.); (S.A.)
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Han K, Huang MQ, Deng X, Shang YC. Remaining Vigilant to Paradoxical Air Embolism in Patients Undergoing Hysteroscopic Surgery: A Case Report and Review of the Literature. J Perianesth Nurs 2021; 36:606-611. [PMID: 34740530 DOI: 10.1016/j.jopan.2021.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/07/2021] [Accepted: 03/08/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this case study and review was to understand the perianesthestic care of paradoxical air embolism (PAE) in patients undergoing hysteroscopic surgery. The perianesthestic management record of a patient undergoing hysteroscopic surgery was analyzed to study the characteristics of PAE, and the literature describing the perianesthestic care for PAE was reviewed. The first symptom of PAE in hysteroscopic surgery is often a decrease in end-tidal carbon dioxide (ETCO2), and the complications include embolism of the pulmonary artery, coronary artery, and cerebral artery. The best monitoring method is continuous ETCO2 monitoring, and intraoperative echocardiography is an excellent method to diagnose and guide the treatment of PAE. PAE is a rare but serious complication of hysteroscopic surgery that is associated with organ ischemia and hypoxia. Prevention and treatment of PAE requires the vigilance and cooperation of not only perianesthesia nurses and anesthesiologists but also the surgeons and operating room nurses. Early prevention, proper monitoring, and effective treatment are the keys to successful rescue for PAE.
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Affiliation(s)
- Kun Han
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
| | - Man-Qiu Huang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yu-Chao Shang
- Department of Anesthesiology, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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Elahmedawy H, Snook NJ. Complications of operative hysteroscopy: an anaesthetist's perspective. BJA Educ 2021; 21:240-242. [PMID: 34178379 DOI: 10.1016/j.bjae.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - N J Snook
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Guo JL, Wang HB, Wang H, Le Y, He J, Zheng XQ, Zhang ZH, Duan GR. Transesophageal echocardiography detection of air embolism during endoscopic surgery and validity of hyperbaric oxygen therapy: Case report. Medicine (Baltimore) 2021; 100:e26304. [PMID: 34115039 PMCID: PMC8202586 DOI: 10.1097/md.0000000000026304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/25/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Air embolism has the potential to be serious and fatal. In this paper, we report 3 cases of air embolism associated with endoscopic medical procedures in which the patients were treated with hyperbaric oxygen immediately after diagnosis by transesophageal echocardiography. In addition, we systematically review the risk factors for air embolism, clinical presentation, treatment, and the importance of early hyperbaric oxygen therapy efficacy after recognition of air embolism. PATIENT CONCERNS We present 3 patients with varying degrees of air embolism during endoscopic procedures, one of which was fatal, with large amounts of gas visible in the right and left heart chambers and pulmonary artery, 1 showing right heart enlargement with increased pulmonary artery pressure and tricuspid regurgitation, and 1 showing only a small amount of gas images in the heart chambers. DIAGNOSES Based on ETCO2 and transesophageal echocardiography (TEE), diagnoses of air embolism were made. INTERVENTIONS The patients received symptomatic supportive therapy including CPR, 100% O2 ventilation, cerebral protection, hyperbaric oxygen therapy and rehabilitation. OUTCOMES Air embolism can causes respiratory, circulatory and neurological dysfunction. After aggressive treatment, one of the 3 patients died, 1 had permanent visual impairment, and 1 recovered completely without comorbidities. CONCLUSIONS While it is common for small amounts of air/air bubbles to enter the circulatory system during endoscopic procedures, life-threatening air embolism is rare. Air embolism can lead to serious consequences, including respiratory, circulatory, and neurological impairment. Therefore, early recognition of severe air embolism and prompt hyperbaric oxygen therapy are essential to avoid its serious complications.
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Affiliation(s)
- Ji-ling Guo
- Guangdong Medical University. Wenming East Road No.2, Zhanjiang
- Department of Anesthesiology
| | | | | | - Yue Le
- Department of Anesthesiology
| | - Jian He
- Department of Anesthesiology
| | | | | | - Guang-rong Duan
- Department of Information, The First People's Hospital of Foshan, North of Ling Nan Road No. 81, Foshan, Guangdong, China
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Ilnitsky S, McClure A, Vilos G, Vilos A, AbuRafea B, Vinden C, McGee J. Complication Rates after Endometrial Ablation in Ontario: A Cohort Analysis of 76 446 Patients. J Minim Invasive Gynecol 2021; 28:1935-1940.e4. [PMID: 33992798 DOI: 10.1016/j.jmig.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/03/2021] [Accepted: 05/05/2021] [Indexed: 10/21/2022]
Abstract
STUDY OBJECTIVES Endometrial ablation (EA) is an alternative to hysterectomy for the management of heavy menstrual bleeding; however, EA is not without risk. Our objective was to determine complication rates in women undergoing EA in the province of Ontario over a 15-year time period. The primary outcome was a composite of multiple complications within 30 to 180 days of surgery. The secondary outcomes included mortality, length of hospital stay, hospital readmission, and emergency department visit within 30 days of discharge. DESIGN Retrospective cohort study using Cochran-Armitage test for trend. SETTING Administrative data from the Canadian province of Ontario, assessing patients undergoing surgery in a publicly funded healthcare system. PATIENTS Women in Ontario undergoing a primary EA over a 15-year time period. INTERVENTIONS The intervention was a primary EA. MEASUREMENTS AND MAIN RESULTS We assessed for genitourinary complication, fistula, gastrointestinal complication, pain, control of bleeding, blood transfusion, infectious complication, venous thromboembolism, fluid overload, thermal injury, and other injuries related to surgery. The secondary outcomes included 1-month and 6-month mortality, length of hospital stay, hospital readmission, and emergency department visit within 30 days of discharge. A total of 76 446 primary EAs were evaluated from 2002 to 2017, with the number of EAs per year increasing over the study period by 47%. Complications were seen in 4.8% of the cohort, with the complication rate being relatively stable over time. Although 6.2% of the cohort re-presented to the emergency department, <1% required readmission, and <0.05% died within 180 days. On multivariable analysis, the risk of complications increased with a preoperative diagnosis of other than bleeding (odds ratio [OR] 2.89; 95% confidence interval [CI], 2.61-3.21; p <.001), previous abdominal surgery (OR 1.42; 95% CI, 1.28-1.56; p <.001), and American Society of Anesthesiologists score 3+ (OR 1.37; 95% CI, 1.27-1.48; p <.001). CONCLUSION Primary EA is associated with complications in <5% of the patients, with serious complications infrequent.
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Affiliation(s)
- Sara Ilnitsky
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - Andrew McClure
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - George Vilos
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - Angelos Vilos
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - Basim AbuRafea
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - Christopher Vinden
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)
| | - Jacob McGee
- Department of Obstetrics & Gynecology, Western University, London, Ontario, Canada (all authors)..
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Hong B, Lee KH, Yoo HJ, Lee J, Yun S, Ahn KT, Chung W. Unexpected development of intraoperative paradoxical air embolism during hysteroscopic myomectomy. J OBSTET GYNAECOL 2019; 40:885-886. [DOI: 10.1080/01443615.2019.1636777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Boohwi Hong
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
| | - Ki Hwan Lee
- Department of Obstetrics and Gynaecology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Obstetrics and Gynaecology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Heon Jong Yoo
- Department of Obstetrics and Gynaecology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Obstetrics and Gynaecology, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Jieun Lee
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Sangwon Yun
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Kye Taek Ahn
- Department of Internal Medicine, Division of Cardiology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Woosuk Chung
- Department of Anaesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, South Korea
- Department of Anaesthesiology and Pain Medicine, School of Medicine, Chungnam National University, Daejeon, South Korea
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