title: Deep sedation without intubation during second trimester surgical termination in an inpatient hospital setting.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA. Electronic address: abigail-mancuso@uiowa.edu.
authors.forename: Abigail C
authors.initials: AC
authors.lastname: Mancuso
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Lee
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.
authors.forename: Ran
authors.initials: R
authors.lastname: Zhang
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Hoover
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Stockdale
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA.
authors.forename: Abbey J
authors.initials: AJ
authors.lastname: Hardy-Fairbanks
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D018686:Anesthetics, Intravenous / Q000627:therapeutic use*; D054810:Deep Sedation / Q000379:methods*; D005260:Female; D006801:Humans; D007297:Inpatients; D007440:Intubation; D007484:Iowa; D061214:Patient Safety; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D015742:Propofol / Q000627:therapeutic use*; D012189:Retrospective Studies; D014619:Vacuum Curettage
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol
keywords: Abortion; Dilation and evacuation; Inpatient; Intubation; Safety