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Safety of Deep Sedation Without Intubation for Second-Trimester Dilation and Evacuation

Aksel, Sarp, MD; Lang, Laura, MD; Steinauer, Jody, E., MD, MAS; Drey, Eleanor, A., MD, EdM; Lederle, Lauren, MD; Sokoloff, Abby, MPH; Carlisle, A., Sue, MD, PhD

doi: 10.1097/AOG.0000000000002692
Family Planning: Original Research: PDF Only

OBJECTIVE: To estimate the incidence of pulmonary aspiration and other anesthesia-related adverse events in women undergoing dilation and evacuation (D&E) under intravenous deep sedation without tracheal intubation in an outpatient setting.

METHODS: We reviewed all D&Es done under anesthesiologist-administered intravenous deep sedation without tracheal intubation between February 2009 and April 2013. The study's primary outcome was pulmonary aspiration; secondary outcomes included other anesthesia-related complications. We calculated the incidence of anesthesia-related adverse events as well as a 95% CI around the point estimate.

RESULTS: During the 51-month study period, 4,481 second-trimester abortions were completed. Of these, 2,523 (56%) were done under deep sedation without tracheal intubation, 652 (26%) between 14 and 19 6/7 weeks of gestation, and 1,871 (74%) between 20 and 24 weeks of gestation. Seven cases of anesthesia-related complications were identified: two cases of pulmonary aspiration (0.08%, 95% CI 0.01–0.29%), four cases of upper airway obstruction (0.016%, 95% CI 0.04–0.41%), and one case of lingual nerve injury (0.04%, 95% CI 0.001–0.22%).

CONCLUSION: Deep sedation without tracheal intubation for women undergoing D&E has a low incidence of anesthesia-related complications.

The incidence of anesthesia-related complications is low in second-trimester dilation and evacuation using deep sedation without intubation.

Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York; and the Departments of Anesthesia and Perioperative Care, Obstetrics, Gynecology and Reproductive Sciences, Medicine, and Anesthesia and Perioperative Care, and the Women's Options Center of Zuckerberg San Francisco General, University of California, San Francisco, and the University of California, San Francisco School of Medicine, San Francisco, California.

Corresponding author: Sarp Aksel, MD, Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, 111E 210th Street, Bronx, NY 10465; email: saksel@montefiore.org.

Supported by the Office of Student Research of Albert Einstein College of Medicine, Bronx, New York, and the Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

Presented at the Annual Meeting of the National Abortion Federation, April 5–8, 2014, San Francisco, CA.

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank Tina Tsang for her assistance with compiling a patient database from billing records in the Office of Billing for the Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General, San Francisco, California; Mercedes Mencinotino for her assistance with compiling a patient database from billing records in the Office of Billing for the Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General, San Francisco, California; Marc Steurer, MD, DESA, for his assistance in reviewing anesthesia protocols and complications, Associate Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; and Matt Cuenot for his assistance with patient chart requests in the Department of Medical Records, Zuckerberg San Francisco General, San Francisco, California.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received November 7, 2017. Received in revised form March 21, 2018. Accepted March 29, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.