A 50-year-old woman is seen in the office for the evaluation of postmenopausal bleeding. Pelvic ultrasound demonstrated an 11 mm endometrial lining. She has a history of diabetes and well-controlled hypertension. She has no known drug allergies. She has a history of prior cesarean sections. After review of technical aspects and risks, consent is obtained. She is placed in dorsal lithotomy position and the vagina is prepped with povidone-iodine. Vaginoscopy is performed using a 3 mm flexible hysteroscope. The vaginal mucosa and endocervical canal appear normal. She reports to the nurse that she is feeling lightheaded and warm. She subsequently states that her vision is blurred and loses consciousness.