Abstract
Objectives
Safety of outpatient dilation and evacuations with intravenous (iv) sedation without
intubation has been demonstrated, but there is a paucity of data on deep iv sedation
on an inpatient second trimester surgical termination population. The purpose of this
study is to evaluate complications of deep sedation with propofol without the use
of intubation during second trimester surgical terminations in an inpatient teaching
institution.
Study design
A retrospective chart review of all obstetrical and anesthetic data from inpatient
dilation and evacuations between gestational ages 15 0/7 and 24 0/7 during the years
2002 to 2015. We examined 332 patient charts. Primary outcomes included suspected
perioperative pulmonary aspiration and conversion to an intubated general anesthesia.
Results
No perioperative pulmonary aspiration cases were either suspected or confirmed. There
were a total of 14 (4.2%) patients that had intubation compared to 313 with natural
airway (94.3%) or laryngeal mask (1.5%). Of the 14 intubated, 9 (64%) were started
with intubation, and 5 (36%) were converted during the procedure (1.7% of those started
with nonintubated anesthesia). Cases requiring intubation were associated with longer
procedure times (p = <0.001), higher American Society of Anesthesiologists (ASA) class (p=0.038), greater
estimated blood loss (p = <0.001) and a primary indication of maternal health (p = <0.001) for the dilation and evacuation.
Conclusions
Deep sedation without intubation appears safe in a hospital setting with few complications
reported.
Implications
Deep sedation without intubation for operating room dilation and evacuation is a safe
option that rarely resulted in conversion to intubation and, in most cases, should
be the anesthesia method of choice at initiation in an inpatient setting.
Keywords
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Article info
Publication history
Published online: October 03, 2016
Accepted:
September 25,
2016
Received in revised form:
September 6,
2016
Received:
November 24,
2015
Footnotes
☆Conflicts of interest: None for all authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
