Factors influencing decision-making for the anesthetic technique in molar pregnancy patients for suction curettage: A retrospective study

Abstract

Anesthetic techniques for suction curettage in molar pregnancy patients described in the literature can be classed into general anesthesia and regional anesthesia techniques. The aim of the present study was to report the factors influencing the decision-making for the choice of anesthetic technique in molar pregnancy patients who underwent suction curettage at Siriraj Hospital. The reported intraoperative and postoperative complications were also analyzed.A retrospective chart review was conducted among pregnant women diagnosed with molar pregnancy who had underwent suction curettage under anesthesia at Siriraj Hospital between January 2007 to September 2021. Overall, 244 patients were diagnosed with molar pregnancy, with 110 of these included for analysis in this study after consideration of the inclusion and exclusion criteria. Quantitative data of the included patients were analyzed by either unpaired t-test or Mann–Whitney U test, while qualitative data were analyzed by the chi-square test. Logistic regression was used to establish the factors influencing the decision-making for the anesthetic technique.General anesthesia was the most preferred anesthetic technique (77.4%) in the molar pregnancy patients who had underwent suction curettage, followed by regional anesthesia (11.3%) and intravenous sedation (11.3%). General anesthesia was likely to be used in patients with an enlarged uterine size ≥ 16 weeks with an adjusted odds ratio of 11.64 (95% CI 1.08–125.72, p < 0.05). Patients with a larger uterine size were associated with higher beta-hCG levels, resulting in more severe medical complications, such as hyperthyroidism and hyperemesis gravidarum (p < 0.05). Intraoperative complications, such as uterine atony (17.7%), massive hemorrhage (7.3%), and pulmonary edema (4.2%), were confined within patients receiving general anesthesia, but there was no statistical significance. None of the patients had anesthesia-related complications. The reported postoperative serious complications, such as pulmonary edema (4.2%), which required postoperative intubation and transferal to the intensive care unit, were all in the general anesthesia group. Patients with higher co-morbidities were advised by anesthesiologists to receive general anesthesia. However, an enlarged uterine size ≥ 16 weeks was the only factor that had an influence on the decisions of the anesthesiologists to provide general anesthesia.