Sami Kaan ÇOŞARCAN, Ömür ECELEN, Alper Tunga DOĞAN

Histereskopik Miyomektomi Sırasında Hava Embolisi: Olgu Sunumu veKanıta Dayalı Yönetim

Operatif histeroskopiler ameliyathane dışında güvenle yapılabilmektedir. Histeroskopik cerrahi sırasında, açıkta kalan uterus damarlarından dolaşıma hava veya gaz girmesi; bu nedenle, pulmoner gaz embolisi, operatif histeroskopi sırasında önemli sonuçlara yol açabilen bir komplikasyondur. Bu olgu sunumunda histeroskopi sırasında gelişen hava veya gaz embolisinden bahsetmek istedik. 21 yaşında, 160 cm, 61 kg ağırlığındaki hasta, histeroskopik miyomektomi için ameliyat edildi. Ameliyatın 70. dakikasında, $ETCO_2$ aniden 35 mmHg’dan, 15 mmHg’ye, $SpO_2$ %93’e geriledi. Transözofagiyal ekokardiyografide sağ atriyumun genişlediği ve sağ atriyum septumunun ciddi şekilde gerildiği gözlendi. Sıvı resusitasyonu ve destek tedavisi sonrasında hemodinamisi düzelen hasta operasyon bitiminde ekstübe edildi. Aşırı Trendelenburg pozisyonundan kaçınma, irigasyon sıvısı seçimi ve basınç kontrolü, cerrahi teknik ve cerrahi süre, koterizasyon seçimi, anestezi ekibinin farkındalığı ve hızlı yanıt verme süresi venöz hava embolisinin tanı ve tedavisinde kritik rol oynamaktadır.

Venous Air Embolism During Hysteroscopic Myomectomy: A Case Report and Evidence Based-Management

Operative hysteroscopic procedures can be performed safely in the outside the operating room. During hysteroscopic surgery, there is a potential risk for air or gas to enter the circulation from exposed uterine veins. Therefore, pulmonary gas embolism is a complication during operative hysteroscopy that can have significant consequences. In this case report, we wanted to talk about air/gas embolism that developed during hysteroscopy. A 21-year-old, 160 cm, 61 kg patient underwent hysteroscopic myomectomy. At the $70^{th}$ minute of surgery, $ETCO_2$ suddenly dropped from 35 mmHg to 15 mmHg, and $SpO_2$ regressed to 93%. Transesophageal echocardiography revealed enlargement of the right atrium and severe stretching of the right atrial septum. The patient, whose hemodynamics improved after fluid resuscitation and cardiac supportive treatment, was extubated at the end of the operation. Avoiding excessive Trendelenburg position, selection of irrigation fluid and pressure control, surgical technique and surgical time, selection of cauterization, awareness of the anesthesia team, and rapid response time play critical roles in the management of venous air or gas embolism.

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