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Case 49 - A 33-Year-Old Woman with Acute Hypoxia during Hysteroscopic Myomectomy

Published online by Cambridge University Press:  19 November 2021

Todd R. Jenkins
Affiliation:
University of Alabama, Birmingham
Lisa Keder
Affiliation:
Ohio State University School of Medicine, Columbus
Abimola Famuyide
Affiliation:
Mayo Clinic, Rochester
Kimberly S. Gecsi
Affiliation:
Medical College of Wisconsin
David Chelmow
Affiliation:
Virginia Commonwealth University School of Medicine
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Summary

A 33-year-old nulligravid woman is undergoing hysteroscopic removal of a 5 cm FIGO type 1 submucosal myoma due to heavy menstrual bleeding and mild anemia. She is otherwise in good health and has no significant medical or surgical history. She is not on any medications and denies drug allergy. The patient receives general anesthesia without difficulty. The procedure commences with use of a fluid management system and a bipolar resectoscope to remove myoma fragments. Approximately 30 minutes into the surgery, the anesthesiologist becomes concerned due to sudden decrease of oxygen saturation to 87%. The total fluid deficit is approaching 2300 mL. The anesthesiologist administers intravenous (IV) furosemide and asks the surgeon to terminate the procedure. Several minutes later, oxygen saturations increase to 92%. The patient is awakened from anesthesia and proceeds to the recovery room in a stable condition.

Type
Chapter
Information
Surgical Gynecology
A Case-Based Approach
, pp. 149 - 151
Publisher: Cambridge University Press
Print publication year: 2021

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References

Munro, MG, Christianson, LA. Complications of hysteroscopic and uterine resectoscopic surgery. Clin Obstet Gynecol 2015; 58: 765–97.CrossRefGoogle ScholarPubMed
Istre, O. Managing bleeding, fluid absorption and uterine perforation at hysteroscopy. Best Pract Res Clin Obstet Gynaecol 2009; 23: 619–29.CrossRefGoogle ScholarPubMed
AAGL: Advancing Minimally Invasive Gynecology Worldwide. AAGL Practice Report: practice guidelines for the diagnosis and management of submucous leiomyomas. J Minim Invasive Gynecol 2012; 19: 152–71.Google Scholar
Umranikar, S, Clark, TJ, Saridogan, E, et al. BSGE/ESGE guideline on management of fluid distension media in operative hysteroscopy. Gynecol Surg 2016; 13: 289303.CrossRefGoogle ScholarPubMed
Deffieux, X, Gauthier, T, Menager, N, et al. Hysteroscopy: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians. Eur J Obstet Gynecol Reprod Biol 2014; 178: 114–22.CrossRefGoogle ScholarPubMed
Soderstrom, RM. Distending the uterus: what medium is best? Clin Obstet Gynecol 1992; 35: 225–8.CrossRefGoogle ScholarPubMed
Friedman, JA, Wong, JMK, Chaudhari, A, Tsai, S, Milad, MP. Hysteroscopic myomectomy: a comparison of techniques and review of current evidence in the management of abnormal uterine bleeding. Curr Opin Obstet Gynecol 2018; 30: 243–51.CrossRefGoogle ScholarPubMed
Lambeck, J, Hieber, M, Dressing, A, Niesen, WD. Central pontine myelinosis and osmotic demyelination syndrome. Dtsch Arztebl Int 2019; 116: 600–6.Google ScholarPubMed
Verma, A, Singh, MP. Venous gas embolism in operative hysteroscopy: a devastating complication in a relatively simple surgery. J Anaesthesiol Clin Pharmacol 2018; 34: 103–6.CrossRefGoogle Scholar

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