Table 1.

Perioperative surgical safety measures in patients undergoing hysteroscopy

Surgical safety measures
After cervical dilation, the cervix should be kept occluded at all times using a dilator or wet gauze.
Repeated insertions and removals of the hysteroscope should be avoided.
Even trivial uterine injury should be informed to anesthetist so that extra vigilance can be kept.
Weighted speculum should be avoided.
Cervical priming (e.g., with misoprostol or Laminaria tents) should be considered especially in nonparous patients or those who had prior cervical surgery.
Intracervical injection of dilute vasopressin can help in reducing VAE risk.
Dilatation and curettage should be performed after hysteroscopy.
If VAE is suspected, surgery should immediately be stopped, uterus deflated, and the cervical os occluded with wet gauzes. Education and training of the surgical staff to raise awareness of the risks and preventive measures.

VAE: venous air embolism