Hysteroscopy
Updated On: July 10, 2026
Anesthetic Approaches
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.
Trendelenburg Position (general considerations): Take precautions for upper airway obstruction or stridor. Avoid excessive fluid administration. OG tube is a good consideration to empty the contents of the stomach. Regurgitation of stomach contents can ulcerate the airway and/or damage the eyes. Consider throat packs and/or eye lubrication to further protect the patient. Brachial nerve injury is also a strong possibility. Be very careful with head and shoulder brace positioning. Peroneal nerve injury is a strong possibility if the patient is also in the lithotomy position. Make sure pressure points are padded. If there's peroneal nerve damage, it will manifest as foot drop. Increased IOP. Take precaution with patients that have glaucoma. Conjunctival swelling will sometimes be irritating to the patient post-operatively. Keep reminding the patient not to rub their eyes. Increased ICP. Cerebral perfusion pressure = MAP-ICP. Make sure you keep the MAP up.
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.