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

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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.

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