The effect of sevoflurane on interventions for blood loss during dilation and evacuation procedures at 18-24 weeks of gestation: a randomized controlled trial.
OBJECTIVE
The objective was to evaluate whether the use of sevoflurane during general anesthesia for dilation and evacuation (D&E) procedures increases the frequency of interventions to treat excess bleeding.


METHODS
A randomized, double-blinded, placebo-controlled trial of a standardized general anesthesia protocol with or without inhaled sevoflurane for D&Es between 18 and 24 weeks' gestation was performed. The primary outcome was need for any intervention to treat blood loss. Secondary outcomes included measured blood loss, procedure time, complications, side effects, patient satisfaction and provider ease of procedure.


RESULTS
One hundred sixty subjects were randomized. Those in the sevoflurane group were slightly more likely to have interventions for bleeding as compared to those subjects who did not receive sevoflurane (25% versus 16.3%, p=.17) or a measured blood loss above 300 mL (15% versus 7.5%, p=.13); however, these differences could have arisen by chance. Most cases of excess bleeding required only minor interventions, including uterine massage and/or uterotonic agents. Procedure time, complications, side effects, satisfaction and ease of procedure were similar between groups.


CONCLUSIONS
Addition of sevoflurane to general anesthesia during a D&E between 18 and 24 weeks' gestation did not increase the risk of intervention for bleeding; however, this study was underpowered to detect clinically important differences.


CONCLUSIONS
In this randomized, double-blinded, placebo-controlled trial, sevoflurane did not significantly increase the risk of intervention for bleeding during D&Es. However, this agent should be used with caution as an anesthetic for surgical abortions.
Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA.
Elizabeth
E
Micks
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
Alison
A
Edelman
California Pacific Medical Center, San Francisco, CA, USA.
Rosanne
R
Botha
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
Paula
P
Bednarek
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
Mark
M
Nichols
Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA.
Jeffrey T
JT
Jensen
D000028:Abortion, Induced / Q000379:methods; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D004107:Dilatation and Curettage / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005865:Gestational Age; D006801:Humans; D008738:Methyl Ethers / Q000009:adverse effects*; D061646:Operative Time; D017060:Patient Satisfaction; D011247:Pregnancy; D000077149:Sevoflurane; D055815:Young Adult
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
Abortion; General anesthesia; Pregnancy termination; Sedation; Volatile anesthetics