Warnings And Precautions - Gynecological; Warnings And Precautions - Gastroenterological And Pulmonary - COOK Medical Rhapsody H-30 User Manual

Warnings and Precautions - Gynecological

• During intrauterine laser surgery, do not use gas or air for cooling the laser fiber tip or for
insufflation. This may cause life-threatening gas or air embolism.
• Patient monitoring: Special precautions should be taken to monitor the patient for fluid
absorption (from hysteroscopic distention media). Excessive fluid absorption is worrisome
if the procedure is prolonged. During the procedure venous channels seem to be open, but
bleeding is controlled by the pressure of the irrigating solution. There is a large raw surface,
and a large volume of fluid may be absorbed. Wider dilation of the cervix to allow irrigating
fluid to flow more freely around the hysteroscope and reduce intrauterine pressure may reduce
the risk. If excessive fluid is absorbed, appropriate therapy such as diuretic administration
should be considered with subsequent electrolyte monitoring.
• Consideration should be given to closing the fallopian tubes prior to an intrauterine procedure
to treat menorrhagia. However, if the physician, after consultation with the patient, determines
that sterilization is not indicated, the patient must be advised to utilize a contraceptive
technique to avoid pregnancy. Although pregnancy is highly unlikely after this type of
procedure, there is no data regarding the potential risks should pregnancy occur.
• Patients are urged to have a pap smear annually. There is a possibility that in the very small
percentage of women who develop uterine cancer, their symptoms of bleeding may be hidden
as a result of this treatment. While other symptoms would still be expected to occur (pain,
other discharges, etc.), a pap smear should be performed to reveal any possible cancerous
development.
• Due to the etiology of the disease, laser treatment of endometriosis and peritoneal adhesions
may result in only temporary improvement. A recurrence of the disease may require
retreatment.
• Distention of the uterine cavity is at the discretion of the operating hysteroscopist. The
recommended distention media for laser hysteroscopy is normal saline (0.9% sodium chloride).

Warnings and Precautions - Gastroenterological and Pulmonary

• "Flash" fire can occur during pulmonary procedures. Do not use general inhalation anesthetics.
Oxygen levels in the procedure room must not be higher than 30%.
• Use caution with patients who have had previous esophageal or tracheal fistulae or episodes
of aspiration.
• After esophageal procedures, swallowing may be paradoxically worsened rather than
immediately improved. This is caused by secondary tissue edema. This potential problem
should be explained to the patient prior to surgery.
Cook Medical © 2019
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Chapter 2
Indications
1-14