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

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


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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abortion, Induced / adverse effects*
  • Abortion, Induced / methods
  • Adult
  • Deep Sedation / adverse effects*
  • Dilatation / adverse effects*
  • Dilatation / methods
  • Female
  • Gestational Age
  • Humans
  • Incidence
  • Pregnancy
  • Pregnancy Trimester, Second
  • Respiratory Aspiration / epidemiology*
  • Respiratory Aspiration / etiology
  • Retrospective Studies