Hysteroscopy

Question 1

What is a hysteroscopy?

Answer 1

A hysteroscopy is a surgical procedure that allows the
endometrial cavity to be examined. It is often used to diagnose
the reason for abnormal uterine bleeding. Often, causes of
bleeding such as myomas and polyps can be removed through
the hysteroscope.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 791.

Question 2

How is a hysteroscopy performed?

Answer 2

The patient is anesthetized and placed in the lithotomy
position. A speculum is inserted into the vaginal canal, a
tenaculum is attached to the cervix, and the hysteroscope is
inserted when the cervix is sufficiently dilated. A distention
media is used to expand the uterus for better visualization of the
uterine structures.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 793.

Question 3

What methods of anesthesia may be used for

hysteroscopy?

Answer 3

Local, regional, or general anesthesia is acceptable for
diagnostic hysteroscopies. If the procedure is an operative
hysteroscopy, then general anesthesia is usually performed.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 793.

Question 4

What is the risk of performing hysteroscopy under a

neuraxial anesthetic?

Answer 4

The patient population that typically presents for a hysteroscopy
(young females) is at particular risk for developing a postdural
puncture headache. If a spinal anesthetic is to be used, a
pencil-point needle is recommend to decrease the risk of PDPH.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 793.

Question 5

What sensory level is sufficient for a hysteroscopy if

a neuraxial anesthetic is employed?

Answer 5

T10
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 793.

Question 6

What distention media are used during a

hysteroscopy?

Answer 6

Normal saline, sorbitol/mannitol 3%, mannitol 5% solutions, and
CO2 are the most commonly used distention media.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 794.

Question 7

What are the risks associated with using CO2 as the

distention media for a hysteroscopy?

Answer 7

If CO2 is used, the flow should be limited to 1200 mL/min and
the intrauterine pressure is kept less than 200 mmHg to reduce
the risk of cardiac arrhythmias. Shoulder pain can result from
the use of CO2.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 794.

Question 8

What nerves are at risk for damage in a patient

undergoing a hysteroscopy and why?

Answer 8

Excessive flexion of the hip joint can cause damage to the
femoral and lateral femoral cutaneous nerves. The obturator
and saphenous nerves are also susceptible to injury resulting
from lithotomy position. The patient’s hands should be placed
on armboards or wrapped in padding if tucked to prevent injury
to the fingers when raising the leg section of the bed.
Jaffe RA, Samuels SI. Anesthesiologist’s Manual of Surgical
Procedures. 4th ed. Philadelphia, PA: Lippincott Williams and
Wilkins, 2009: 794.