Value of noninvasive hemodynamic monitoring in predicting the gas embolus during hysteroscopic surgery

LIU Sheng-qun; LI Chao-wei; LV Su-ping; LIU Yue-qiang; LI Zhan-wen; ZHAO Su-zhen

doi:10.3969/j.issn.1002-266X.2014.30.003

Abstract：Objective To explore the value of noninvasive hemodynamic monitoring in predicting the gas embolus dur -ing hysteroscopic surgery .Methods A total of 120 patients, undergoing hysteroscopic surgery under general anesthesia were involved in this study (41 intrauterine adhesion , 35 endometrial polyp , 28 submucous uterine myoma , 9 uterus medi-astinum , 7 trophoblastic residual ) .Gas embolus in the common iliac vein , superior vena cava , inferior vena cava and heart cardiac were continuously monitored by using color Doppler ultrasonic imaging .The haemodynamic indexes were monitored by noninvasive hemodynamic monitoring.ECG, SpO2, PET CO2 were monitored as well.The operation time, blood loss, the appearance time of gas embolus , the appearance time of highest gas embolus and then the change of HR ( when HR >120 bpm or increased 30%compared with baseline ), PETCO2(when it was reduced more than10%compared with baseline or 3 mmHg) were recorded.The HR, MBP, SpO2 , PET CO2 , SV/SVI, CO/CI, SVR/SVRI, TFC, VI, ACI, PEP, LVET, STR, LCW/LCWI were recorded when appearance of the gas embolus (T1), the highest gas embolus appeared (T2), and the HR rise(T3), and when the PETCO2 decline (T4),the gas embolus disappeared(T5).Results Gas embo-lus donn't appeared(group A) in 76 patients of all the 120(63.3%).Gas embolus appeared in 44 patients(36.7%).A small number of gas embolus occurred in 27 cases(group B, 22.5%).A moderate number of gas embolus occurred in 10 cases(group C, 8.3%).A large number of gas embolus occurred in 7 cases(group D, 5.8%).The blood loss and opera-tion time of group D were significantly higher than the other groups (all P<0.05).There was no statistical differences in four groups at the appearance time of gas embolus , HR, PET CO2 , MBP, SpO2 , PET CO2 , SV/SVI, CO/CI, SVR/SVRI, TFC, VI, ACI, PEP, LVET, STR, LCW/LCWI.When the patients developed gas embolus , the operation were suspend , simultaneously, the left-Rlateral and head-Rdown position should be taken to avoid serious complications ( dead or disabli-ty) because of gas embolism .Conclusion There were no value of noninvasive hemodynamic monitoring in predicting the gas embolus during hysteroscopic surgery .But the ultrasonography can monitoring the gas embolus during hysteroscopic sur -gery immediately.