A brief presentation on how to proceed with anaesthesia for hysteroscopy. This endoscopic procedure is being more and more performed, especially by infertility experts. Most of the procedures go off in a jiffy; but the going gets tough when this simple endoscopy gets prolonged or the operator decides to go for an intervention.

1. Dr. Atul Dixit, MD
Professor of Anaesthesiology
Mohak Hi-Tek Hospital (SAIMS)
Indore

2. Pre-anaesthetic Checkup (PAC):
 Presuming that investigations are within normal limits
 Check nil-by-mouth status
 History of:
 hypothyroidism,
 asthma,
 drug allergy,
 Hypertension
 Depression (MAOI inhibitors) / Epilepsy
 Status of joints: hip / shoulder / elbow – Positioning
 Trans-vaginal sonography
2Dr. Atul Dixit, MD

3. The Anaesthesia – Option-1:
 Insert IV canulla 22 / 20 G in left arm: easily reachable
 Usually IV fluids are not required if spinal is avoided
 Spinal analgesia with lidocaine or bupivacaine heavy
 Time consuming (draping painting positioning & LP)
 Not preferable if the OT list is large
 Patient blocks the bed for a longer period of time
 Adds cost of IV fluids to the procedure
 Technique of choice for interventional hysteroscopy:
septum / fibroid / TCRE
3Dr. Atul Dixit, MD

4. The Anaesthesia – Option-2
 TIVA (Total Intra Venous Anaesthesia)
 Most commonly employed
 Oxygen by mask @ 4 LPM; Monitor SpO2 + NIBP
 Premed: IV glycopyrollate 0.2mg + IV midazolam 1-2
mg + IV fentanyl 100µgms diluted to 10 ml
 Patient is positioned, legs put in the stirrups, draped &
painted. Talk & gain confidence of patient.
 Try and judge the mental make up of the patient
 If needed IV propofol 1% 2.5 ml bolus till completion
4Dr. Atul Dixit, MD

5. The Anaesthesia: Option-3
 GA with LMA or intubation:
 Will have to be employed if:
 Procedure gets extended beyond expectations or gets
converted into an interventional one
 Leading to tachypnoea and fall in oxygen saturation
due to absorption of IV glycine infusion
 On the table or postoperatively, go for serum electrolyte
measurements
 Airway is difficult to maintain due to weight of patient
or obstructive airway disease
5Dr. Atul Dixit, MD

6. Dr. Atul Dixit, MD 6
Thank You!