CARBON-DIOXIDE EMBOLISM WITH TRANSIENT BL INDNESS ASSOCIATED WITH HYSTEROSCOPY

A 43 year-old woman, with uterine bleeding and right ovary cyst, was s cheduled for hysteroscopy-curettage and laparoscopy. Her history was u nremarkable. After induction of general anaesthesia and tracheal intub ation (propofol, fentanyl, vecuronium), anesthesia was maintained with N2O/O-2 (60%/40%) and isoflurane 1 vol %. The patient was placed in t he dorsal lithotomy position. Two minutes after the beginning of CO2 i nsufflation for hysteroscopy, a ventricular tachycardia with a circula tory arrest suddenly occurred. Insufflation was stopped, cardiopulmona ry resuscitation started and lignocaine 100 mg iv administered. The ha emodynamic status improved rapidly with a return to sinusal rhythm and stable blood pressure within two minutes. In the recovery room, the p atient was restless and experienced blindness for 3 hours. Physical ex amination and all investigations (EEG, brain CT scan, carotid Doppler and transoesophageal echocardiography) were normal. The most probable diagnosis was a CO2 venous embolism associated with an arterial parado xal embolism responsible for the temporary blindness.