Hysteroscopy

Anesthesia Implications

Position: Lithotomy, Trendelenburg, arms extended
Time: 30-60 min (short)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

If using the MAC approach – it has been suggested to use propofol (intermittent bolus or continuous infusion) with versed and low dose ketamine (12.5 – 50mg) . The surgeon may perform a paracervical block. This approach is great for quick discharge and high patient satisfaction.

Postop – Anticipate postoperative cramping/pain. IV NSAIDs (most often ketorolac) are very effective/common to treat this pain.

The uterus is visualized by insertion of a hysteroscope through the vagina and cervix. The uterus is inflated using carbon dioxide gas or fluid, which allows inspection of the uterine cavity. Instruments are then passed into the uterus to allow biopsy, excision, etc of anything found.

These surgeries are rarely done in isolation. You will see these coupled with dilation and curettage (D&C) and dilation and evacuation (D&E) procedures.