Prospective Study Investigating Change in Carboxyhemoglobin Blood Level during Operative Hysteroscopy. 

 -  2022 
<br/><br/> CONCLUSION: This study demonstrates that systemic absorption of carbon monoxide is a reproducible phenomenon in hysteroscopic resections using bipolar diathermy. Greater absorption is associated with a higher fluid deficit and greater fibroid volume. Although none of the subjects with an abnormal increase screened positive for symptoms in the post-operative setting and only one experienced hemodynamic changes intra-operatively, our study looked at a healthy and young patient population. More research is needed on the safety of this COHb exposure in patients with medical comorbidities. Special consideration should be given to the possibility of carbon monoxide absorption and the uncertain long-term effects when planning extensive hysteroscopic resections. Copyright © 2022. Published by Elsevier Inc.  DESIGN: A prospective cross-sectional study of 40 subjects undergoing a hysteroscopic procedure using bipolar radiofrequency (RF) energy.  MEASUREMENTS AND MAIN RESULTS: 17.5% of subjects met the criteria for abnormal post-op COHb levels. None of these subjects reported symptoms of carbon monoxide toxicity. One subject with an elevated post-op COHb level had intra-operative hemodynamic changes possibly related to COHb elevation. An abnormal postop COHb level was associated with a higher fluid deficit (p-value 0.024) and greater fibroid volume (p-value 0.04).  SETTING, PATIENTS AND INTERVENTIONS: The study was conducted at an ambulatory surgery center. Procedures for uterine leiomyoma, septa, products of conception, or a combination of these pathologies were included. We measured blood carboxyhemoglobin (COHb) levels prior to and immediately after the surgery. Abnormal post-op COHb level was defined as an increase of plasma carboxyhemoglobin >= 3.0%. All patients with abnormal post-operative levels were contacted and screened for carbon monoxide toxicity symptoms. Summary statistics included frequency for categorical variables and averages for continuous variables. P-values were reported without modification.  STUDY OBJECTIVES: To evaluate whether the use of radiofrequency energy during resectoscopy leads to increases in patient blood levels of carboxyhemoglobin and investigate procedural variables associated with these elevations. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1553-4650 
<br/><br/><label>Standard No.: </label>10.1016/j.jmig.2022.09.002 [doi] S1553-4650(22)00361-2 [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>IN PROCESS -- NOT YET INDEXED
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Washington Hospital Center
<br/><br/><label>Index Terms--Occupation: </label><br/>Minimally Invasive Gynecologic Surgery Fellowship<br/>Obstetrics and Gynecology/Minimally Invasive Gynecologic Surgery
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article