Table 2.

Safety measures during anesthesia for hysteroscopic procedures

Anesthesia safety measures
The patient should be placed in the supine/reverse Trendelenburg position.
Height of fluid bottles should be restricted to<1 m above the patient and external pressure infuser avoided.
Automated pumps should preferably be used for irrigating fluid and the hysteromat set and all tubings should be purged free of air bubbles.
A continuous outflow system should be used so that the distension medium is restored actively and bubbles and debris are flushed away.
An isotonic solution (0.9% NaCl) should be used as distension medium.
When infusion fluid deficit is >1000 mL with sorbitol or >1500 mL with saline, need of early termination of the procedure should be discussed with the surgeon.
Intrauterine pressure monitoring system should be used and pressure limited to <100 mm Hg.
EtCO2 monitoring is mandatory in all cases. Advanced hemodynamic monitoring (cardiac Doppler) should be used especially in patients at high risk (e.g., ASD/VSD) undergoing operative hysteroscopy.
Resuscitation equipment and drugs along with central venous catheters and arterial cannulas should be kept ready to tackle emergency.
Patient should be kept optimally hydrated.
Positive pressure ventilation should be used while nitrous oxide (N2O) avoided.