The Journal of the American Association of Gynecologic Laparoscopists
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J Am Assoc Gynecol Laparosc · Aug 1996
Randomized Controlled Trial Clinical TrialThe degree of fluid absorption during hysteroscopic surgery in patients pretreated with goserelin.
To assess the effects of pretreatment with the gonadotropin-releasing hormone analog goserelin on fluid absorption in patients undergoing hysteroscopic endometrial ablation. ⋯ Based on these results we conclude that in women undergoing hysteroscopic endometrial ablation, pretreatment with goserelin may decrease the absorption of hysteroscopic medium, prevent fluid overload, and improve the outcome possibly by causing hypovascularity and decreased endometrial growth.
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Accidental vascular placement of Veress needle or cannula during laparoscopic insufflation with carbon dioxide gas (CO2) may cause a fatal gas embolism. Deliberate CO2 injection into the vena cava of dogs did not define a safe flow rate or pressure to prevent mortality. We studied incremental increase in pressure at the same maximum rate of gas flow (corresponding to 2.5 L/mm in a 70-kg man, the maximum flow rate possible with a Veress needle) to define the pressure at which pigs did not reversibly tolerate intravenous CO2 insufflation. ⋯ However, a decrease in end tidal CO2 should alert the anesthesiologist to stop insufflation immediately. This will allow recovery. When insufflating pressures are in the middle (20 mm Hg) or high range (25 mm Hg), CO2 embolism can be fatal despite its early recognition.