Intravenous Sedation Without Intubation and the Risk of Anesthesia Complications for Obese and Non-Obese Women Undergoing Surgical Abortion

Gokhale, Priyanka; Lappen, Justin R.; Waters, Jonathan H.; Perriera, Lisa

doi:10.1097/sa.0000000000000270

Cited by 6 publications

(8 citation statements)

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“…General anaesthesia/deep IV sedation alleviated pain during surgical TOP, with no benefit of additional adjuvant therapy. Although deep IV sedation with propofol can safely be provided without intubation for women undergoing second-trimester surgical TOP in the outpatient setting, [33][34][35] both of these modalities require specially trained staff, specialised equipment and are resource intensive. An alternative is a multimodal approach to pain management during second-trimester surgical TOP, including moderate IV sedation with opioids and anxiolytics, PCB and pre-procedure NSAIDs.…”

Section: Discussionmentioning

confidence: 99%

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Jackson¹,

Kapp²

2020

BJOG

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Background High‐quality care for termination of pregnancy (TOP) requires pain to be effectively managed; however, practices differ, and the available guidelines do not specify optimal strategies. Objective To guide providers in effective pain management for second‐trimester medical and surgical TOP. Search strategy We searched PubMed, Cochrane and Embase databases, and the US National Library of Medicine clinical trials registry, from inception to the end of June 2019, and hand‐searched reference lists. Selection criteria Trials comparing pain management strategies with no treatment, placebo or active interventions during induced medical or surgical TOP, occurring between 13 and 24 weeks of gestation, and reporting direct or indirect measures of pain. Data collection and analysis Both authors summarised and systematically assessed the evidence and risk of bias using standard tools. Main results We included seven medical and four surgical TOP studies, with 453 and 349 participants, respectively. The heterogeneity of interventions and outcomes prevented pooled analyses. Medical TOP: women receiving routine or continuous epidural analgesia experienced mild pain. The prophylactic use of nonsteroidal anti‐inflammatory drugs (NSAIDs) decreased pain (mean difference −0.5, P < 0.001) and additional opioid requirements (3.5 versus 7 mg, P = 0.04) compared with placebo/other treatment. Paracervical block was ineffective. No studies assessed intramuscular (IM)/intravenous (IV) opioid or nonpharmacological treatment. Surgical TOP: general anaesthesia/deep IV sedation alleviated pain. Nitrous oxide was ineffective. No studies assessed moderate IV sedation, IV/IM opioid, paracervical block without sedation, NSAID or nonpharmacological treatment. Conclusion Based on limited data, regional analgesia and NSAIDs mitigated second‐trimester medical TOP pain; general anaesthesia/deep IV sedation alleviated surgical TOP pain. Tweetable abstract Although women experience intense pain during second‐trimester termination of pregnancy, few data are available to inform their treatment.

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Section: Discussionmentioning

confidence: 99%

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Jackson¹,

Kapp²

2020

BJOG

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“…However, this study evaluated procedures performed in a hospital operating room with general anesthesia and had limited power to evaluate anesthesia-specific events. A recent study evaluating anesthesia complications among 5,579 obese and non-obese women undergoing first and second trimester abortion utilizing fentanyl, midazolam, and propofol without intubation in a freestanding clinic reported no serious adverse outcomes in either group and concluded that based on the upper 95% confidence interval for their sample size, the maximal risk of a serious anesthesia-related complication was 1 in 1,860 procedures [19].…”

Section: Discussionmentioning

confidence: 99%

Moderate intravenous sedation for first trimester surgical abortion: a comparison of adverse outcomes between obese and normal-weight women

et al. 2018

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“…Partially because of its rapid recovery profile, propofol is the most frequently used intravenous anaesthetic today and has achieved widespread use in outpatient surgery . Opioid μ receptor agonists, such as sufentanil or fentanyl , are the main analgesics used. Although the period of outpatient‐induced abortion is usually very short, patients do not leave the hospital until dizziness and pain are absent.…”

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confidence: 99%

The ED₉₅ of Nalbuphine in Outpatient‐Induced Abortion Compared to Equivalent Sufentanil

Chen

Zhou

Cai

et al. 2018

Basic Clin Pharma Tox

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This prospective study evaluated the 95% effective dose (ED ) of nalbuphine in inhibiting body movement during outpatient-induced abortion and its clinical efficacy versus the equivalent of sufentanil. The study was divided into two parts. For the first part, voluntary first-trimester patients who needed induced abortions were recruited to measure the ED of nalbuphine in inhibiting body movement during induced abortion using the sequential method (the Dixon up-and-down method). In the second part, this was a double-blind, randomized study. Sixty cases of first-trimester patients were recruited and were randomly divided into two groups (n = 30), including group N (nalbuphine at the ED dose) and group S (sufentanil at an equivalent dose). Propofol was given to both groups as the sedative. The circulation, respiration and body movement of the two groups in surgery were observed. The amount of propofol, the awakening time, the time to leave the hospital and the analgesic effect were recorded. The ED of nalbuphine in inhibiting body movement during painless surgical abortion was 0.128 mg/kg (95% confidence intervals 0.098-0.483 mg/kg). Both nalbuphine and the equivalent dose of sufentanil provided a good intraoperative and post-operative analgesic effect in outpatient-induced abortion. However, the post-operative morbidity of dizziness for nalbuphine was less than for sufentanil (p < 0.05), and the awakening time and the time to leave the hospital were significantly shorter than those of sufentanil (p < 0.05). Nalbuphine at 0.128 mg/kg was used in outpatient-induced abortion as an intraoperative and post-operative analgesic and showed a better effect compared with sufentanil.

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Intravenous Sedation Without Intubation and the Risk of Anesthesia Complications for Obese and Non-Obese Women Undergoing Surgical Abortion

Cited by 6 publications

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Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Moderate intravenous sedation for first trimester surgical abortion: a comparison of adverse outcomes between obese and normal-weight women

The ED₉₅ of Nalbuphine in Outpatient‐Induced Abortion Compared to Equivalent Sufentanil

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Intravenous Sedation Without Intubation and the Risk of Anesthesia Complications for Obese and Non-Obese Women Undergoing Surgical Abortion

Cited by 6 publications

References 0 publications

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review

Moderate intravenous sedation for first trimester surgical abortion: a comparison of adverse outcomes between obese and normal-weight women

The ED95 of Nalbuphine in Outpatient‐Induced Abortion Compared to Equivalent Sufentanil

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The ED₉₅ of Nalbuphine in Outpatient‐Induced Abortion Compared to Equivalent Sufentanil