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Venous air embolism during total laparoscopic hysterectomy: comparison to total abdominal hysterectomy

 Chang Seok Kim  ;  Ji Young Kim  ;  Ja-Young Kwon  ;  Seung Ho Choi  ;  Sungwon Na  ;  Jiwon An  ;  Ki Jun Kim 
 ANESTHESIOLOGY, Vol.111(1) : 50-54, 2009 
Journal Title
Issue Date
Adult ; Embolism, Air/epidemiology* ; Embolism, Air/etiology* ; Female ; Humans ; Hysterectomy/adverse effects* ; Hysterectomy/methods ; Intraoperative Complications/epidemiology ; Intraoperative Complications/etiology ; Laparoscopy/adverse effects* ; Laparoscopy/methods ; Middle Aged
BACKGROUND: Total laparoscopic hysterectomy (TLH) has become a widely accepted alternative to total abdominal hysterectomy (TAH). The aim of this study was to compare the incidence and grade of venous air embolism (VAE) in TLH to those in TAH using transesophageal echocardiography.

METHODS: Eighty-two American Society of Anesthesiologists physical status I patients scheduled for either TLH or TAH were enrolled. After induction of general anesthesia, a multiplane transesophageal echocardiography probe was inserted. The midesophageal four-chamber or bicaval view was continuously monitored. An independent transesophageal echocardiography-certified anesthesiologist graded VAE.

RESULTS: All patients undergoing TLH showed VAE, and 37.5% of patients had VAE grade higher than III. Fifteen percent of patients undergoing TAH showed VAE, and all of them were grade I. No patient in this study showed hemodynamic instability or electrocardiogram changes at the time of VAE occurrence. Most instances of VAE during TLH occurred during transection of the round ligament and dissection of the broad ligament.

CONCLUSION: The incidence of VAE in patients undergoing TLH was 100%. VAE grade in TLH was higher compared to that in TAH, especially during transection of the round ligament and dissection of the broad ligament. Although the hemodynamic instability associated with VAE during TLH was not observed in this study, anesthesiologists must be vigilant for detection of VAE during TLH.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Obstetrics and Gynecology (산부인과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ja Young(권자영) ORCID logo https://orcid.org/0000-0003-3009-6325
Kim, Ki Jun(김기준) ORCID logo https://orcid.org/0000-0003-1950-7998
Kim, Ji Young(김지영) ORCID logo https://orcid.org/0000-0001-5822-0338
Na, Sungwon(나성원) ORCID logo https://orcid.org/0000-0002-1170-8042
Choi, Seung Ho(최승호) ORCID logo https://orcid.org/0000-0001-8442-4406
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