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Obstet Gynecol. 2018 Jul;132(1):171-178. doi: 10.1097/AOG.0000000000002692.

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

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Department of Obstetrics & Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York; and the Departments of Anesthesia and Perioperative Care, Obstetrics, Gynecology and Reproductive Sciences, Medicine, and Anesthesia and Perioperative Care, and the Women's Options Center of Zuckerberg San Francisco General, University of California, San Francisco, and the University of California, San Francisco School of Medicine, San Francisco, California.



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.


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.


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%).


Deep sedation without tracheal intubation for women undergoing D&E has a low incidence of anesthesia-related complications.

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