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Deng X, Zhou J, Diao M, Li H, Lin X. Effects of different fractions of inspired oxygen on gas embolization during hysteroscopic surgery: A double-blind, randomized, controlled trial. Int J Gynaecol Obstet 2024; 164:1101-1107. [PMID: 37789807 DOI: 10.1002/ijgo.15159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVE Gas embolism is a common complication of hysteroscopic surgery that causes serious concern among gynecologists and anesthesiologists due to the potential risk to patients. The factors influencing gas embolism in hysteroscopic surgery have been extensively studied. However, the effect of the oxygen concentration inhaled by patients on gas embolism during hysteroscopic surgery remains elusive. Therefore, we designed a double-blind, randomized, controlled trial to determine whether different inhaled oxygen concentrations influence the occurrence of gas embolism during hysteroscopic surgery. METHODS This trial enrolled 162 adult patients undergoing elective hysteroscopic surgery who were randomly divided into three groups with inspired oxygen fractions of 30%, 50%, and 100%. Transthoracic echocardiography (four-chamber view) was used to evaluate whether gas embolism occurred. Before the start of surgery, the four-chamber view was continuously monitored. RESULTS The number of gas embolisms in the 30%, 50%, and 100% groups was 36 (69.2%), 30 (55.6%), and 24 (44.4%), respectively. The incidence of gas embolism gradually decreased with increasing inhaled oxygen concentration (P = 0.031). CONCLUSION In hysteroscopic surgery, a higher oxygen concentration inhaled by patients may reduce the incidence of gas embolism, indicating that a higher inhaled oxygen concentration, especially 100%, could be recommended for patients during hysteroscopic surgery. TRIAL REGISTRATION Chinese Clinical Trial Registry (https://www.chictr.org.cn/showproj.html?proj=53779, Registration number: ChiCTR2000033202).
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Affiliation(s)
- Xi Deng
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Jieshu Zhou
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Min Diao
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Hao Li
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
| | - Xuemei Lin
- Department of Anesthesiology, West China Second University Hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, People's Republic of China
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Liu SQ, Zhao SZ, Li ZW, Lv SP, Liu YQ, Li Y. Monitoring of Gas Emboli During Hysteroscopic Surgery: A Prospective Study. J Ultrasound Med 2017; 36:749-756. [PMID: 28150413 DOI: 10.7863/ultra.16.03051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Previous studies have demonstrated a high frequency of gas emboli during hysteroscopy, but guidelines for the prevention, early detection, and intervention of gas embolism during hysteroscopic procedures are still lacking. This study aimed to gain a clearer understanding of risk factors and specific signs and symptoms associated with gas emboli. METHODS This prospective study enrolled 120 women scheduled for hysteroscopy using 5% glucose as distension medium. The gas bubbles were monitored sequentially in internal iliac vein, common iliac vein, inferior vena cava, superior vena cava, heart, and pulmonary artery under the gray-scale imaging of Doppler ultrasound. The frequency, extent, and the hemodynamic and respiratory effects of gas emboli were evaluated. The interventions and outcomes were recorded. The risk factors associated with gas emboli, and their relationship with the frequency and extent of gas emboli, were assessed. RESULTS In our study, evidence of gas emboli under Doppler ultrasound monitoring was observed in 44 (36.7%) patients. The operation was continued and finished as soon as possible for patients presenting with stable vital signs or transient hemodynamic and respiratory changes, which resolved spontaneously without intervention. The operation was paused for patients presenting with significant hemodynamic changes or loss of consciousness, and the operation was resumed shortly after resumption of stable vital signs following symptomatic treatment. All patients in our study finished the operation and recovered without developing serious complications. Data analysis showed prolonged procedure duration and increased bleeding volume were both positively correlated with the frequency and extent of gas emboli. CONCLUSION Our study demonstrated a high frequency of gas emboli during hysteroscopy. Doppler ultrasonic monitoring combined with a clearer understanding of specific signs, symptoms, and risk factors will facilitate early detection and intervention of gas emboli during hysteroscopy.
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Affiliation(s)
- Sheng-Qun Liu
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Su-Zhen Zhao
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Zhan-Wen Li
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Su-Ping Lv
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Yue-Qiang Liu
- Departments of Anesthesiology, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Yi Li
- Experimental Medicine , Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, Henan, 450003, China
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Bernaldo de Quirós Y, Møllerløkken A, Havnes MB, Brubakk AO, González-Díaz O, Fernández A. Bubbles Quantified In vivo by Ultrasound Relates to Amount of Gas Detected Post-mortem in Rabbits Decompressed from High Pressure. Front Physiol 2016; 7:310. [PMID: 27493634 PMCID: PMC4954815 DOI: 10.3389/fphys.2016.00310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/07/2016] [Indexed: 11/30/2022] Open
Abstract
The pathophysiological mechanism of decompression sickness is not fully understood but there is evidence that it can be caused by intravascular and autochthonous bubbles. Doppler ultrasound at a given circulatory location is used to detect and quantify the presence of intravascular gas bubbles as an indicator of decompression stress. In this manuscript we studied the relationship between presence and quantity of gas bubbles by echosonography of the pulmonary artery of anesthetized, air-breathing New Zealand White rabbits that were compressed and decompressed. Mortality rate, presence, quantity, and distribution of gas bubbles elsewhere in the body was examined postmortem. We found a strong positive relationship between high ultrasound bubble grades in the pulmonary artery, sudden death, and high amount of intra and extra vascular gas bubbles widespread throughout the entire organism. In contrast, animals with lower bubble grades survived for 1 h after decompression until sacrificed, and showed no gas bubbles during dissection.
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Affiliation(s)
- Yara Bernaldo de Quirós
- Veterinary Histology and Pathology, Department of Morphology, Veterinary School, Institute of Animal Health, University of Las Palmas de Gran Canaria Las Palmas, Spain
| | - Andreas Møllerløkken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway
| | - Marianne B Havnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway
| | - Alf O Brubakk
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology Trondheim, Norway
| | - Oscar González-Díaz
- Physical and Chemical Instrumental Center for the Development of Applied Research Technology and Scientific Estate, University of Las Palmas de Gran Canaria Las Palmas, Spain
| | - Antonio Fernández
- Veterinary Histology and Pathology, Department of Morphology, Veterinary School, Institute of Animal Health, University of Las Palmas de Gran Canaria Las Palmas, Spain
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Byrne B, Sherwin R, Courage C, Baylor A, Dolcourt B, Brudzewski JR, Mosteller J, Wilson RF. Hyperbaric oxygen therapy for systemic gas embolism after hydrogen peroxide ingestion. J Emerg Med 2013; 46:171-5. [PMID: 24268898 DOI: 10.1016/j.jemermed.2013.08.091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 08/15/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hydrogen peroxide is a commonly available product and its ingestion has been demonstrated to produce in vivo gas bubbles, which can embolize to devastating effect. OBJECTIVE We report two cases of hydrogen peroxide ingestion with resultant gas embolization, one to the portal system and one cerebral embolus, which were successfully treated with hyperbaric oxygen therapy (HBO), and review the literature. CASE REPORT Two individuals presented to our center after unintentional ingestion of concentrated hydrogen peroxide solutions. Symptoms were consistent with portal gas emboli (Patient A) and cerebral gas emboli (Patient B), which were demonstrated on imaging. They were successfully treated with HBO and recovered without event. CONCLUSIONS As demonstrated by both our experience as well as the current literature, HBO has been used to successfully treat gas emboli associated with hydrogen peroxide ingestion. We recommend consideration of HBO in any cases of significant hydrogen peroxide ingestion with a clinical picture compatible with gas emboli.
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Affiliation(s)
- Brendan Byrne
- Department of Emergency Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Robert Sherwin
- Department of Emergency Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan; Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Cheryl Courage
- Department of Emergency Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Alfred Baylor
- Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan; Department of Surgery, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Bram Dolcourt
- Department of Emergency Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan; Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Jacek R Brudzewski
- Department of Emergency Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan; Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Jeffrey Mosteller
- Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
| | - Robert F Wilson
- Department of Surgery, Section of Hyperbaric Medicine, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan; Department of Surgery, Detroit Receiving Hospital, Detroit Medical Center/Wayne State University, Detroit, Michigan
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de Quirós YB, González-Diaz O, Arbelo M, Sierra E, Sacchini S, Fernández A. Decompression vs. Decomposition: Distribution, Amount, and Gas Composition of Bubbles in Stranded Marine Mammals. Front Physiol 2012; 3:177. [PMID: 22675306 PMCID: PMC3366475 DOI: 10.3389/fphys.2012.00177] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 05/14/2012] [Indexed: 11/13/2022] Open
Abstract
Gas embolic lesions linked to military sonar have been described in stranded cetaceans including beaked whales. These descriptions suggest that gas bubbles in marine mammal tissues may be more common than previously thought. In this study we have analyzed gas amount (by gas score) and gas composition within different decomposition codes using a standardized methodology. This broad study has allowed us to explore species-specific variability in bubble prevalence, amount, distribution, and composition, as well as masking of bubble content by putrefaction gases. Bubbles detected within the cardiovascular system and other tissues related to both pre- and port-mortem processes are a common finding on necropsy of stranded cetaceans. To minimize masking by putrefaction gases, necropsy, and gas sampling must be performed as soon as possible. Before 24 h post mortem is recommended but preferably within 12 h post mortem. At necropsy, amount of bubbles (gas score) in decomposition code 2 in stranded cetaceans was found to be more important than merely presence vs. absence of bubbles from a pathological point of view. Deep divers presented higher abundance of gas bubbles, mainly composed of 70% nitrogen and 30% CO2, suggesting a higher predisposition of these species to suffer from decompression-related gas embolism.
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Affiliation(s)
- Yara Bernaldo de Quirós
- Veterinary Histology and Pathology, Department of Morphology, Institute of Animal Health, Veterinary School, University of Las Palmas de Gran Canaria Las Palmas, Spain
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