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Preparation for operative hysteroscopy and anesthesia
Last reviewed: 04.07.2025
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Preoperative preparation for surgical hysteroscopy and pain relief
Preoperative preparation for surgical hysteroscopy is no different from that for diagnostic hysteroscopy. When examining a patient and preparing for a complex hysteroscopic operation, it is important to remember that any operation can end with laparoscopy or laparotomy.
Regardless of the complexity and duration of the operation (even for the shortest manipulations), it is necessary to have a fully equipped operating room in order to promptly recognize and begin treatment of possible surgical or anesthetic complications.
Simple hysteroscopic operations use the same types of anesthesia as diagnostic hysteroscopy. These operations can be performed under local anesthesia (paracervical solution of novocaine or lidocaine), but it is necessary to remember about possible allergic reactions to the drugs administered. It is preferable to use intravenous anesthesia (ketalar, diprivan, sombrevin), if a long operation (over 30 minutes) is not planned. For longer operations, endotracheal anesthesia or epidural anesthesia can be used, but if hysteroscopy is combined with laparoscopy, in our opinion, endotracheal anesthesia is preferable.
A special problem for anesthesiologists is ablation (resection) of the endometrium and myomectomy due to possible anesthetic complications and difficulties in assessing blood loss and fluid balance. During such operations, absorption of fluid introduced into the uterine cavity into the vascular bed is inevitable. The anesthesiologist must monitor the balance of injected and excreted fluid and inform the surgeon about the fluid deficit. If the fluid deficit is 1000 ml, it is necessary to speed up the completion of the operation. A fluid deficit of 1500-2000 ml is an indication for urgent termination of the operation. During surgery under general anesthesia, it is quite difficult to determine signs of hyperhydration before pulmonary edema occurs. Therefore, many anesthesiologists prefer to perform these operations under epidural or spinal anesthesia.
Women who refuse epidural or spinal anesthesia or have contraindications to this type of pain relief are operated on under endotracheal anesthesia. During the operation, it is necessary to determine the concentration of blood electrolytes and, preferably, the central venous pressure. If signs of fluid absorption syndrome (EFAS - Endoscopic Fluid Absorption Syndrome) appear, diuretics are administered and infusion therapy is performed under the control of blood electrolyte levels.
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