Abstract
ObjectiveTo determine if obese women experience increased rates of adverse outcomes with moderate intravenous sedation during first trimester surgical abortion compared to normal weight women. Study designWe performed a retrospective cohort study of all first trimester surgical abortions with moderate intravenous sedation at an outpatient facility between September 2010 and June 2015. The primary outcome was supplemental oxygen administration. Secondary outcomes included reversal agent administration, anesthesia-related adverse events, and intraoperative lowest level of consciousness (LLOC). We compared three obesity groups [I (Body Mass Index, BMI=30–34.9), II (BMI=35–39.9), and III (BMI ≥40)] to normal weight women (BMI <25). We exported data from electronic medical records and reviewed adverse outcomes individually. ResultsOf 20,381 first trimester surgical abortion procedures, 31 (0.15%) utilized supplemental oxygen, 24 (0.12%) utilized a reversal agent, 40 (0.20%) had a presumed anesthesia-related adverse event and 184 of 19,725 (0.93%) had a documented low intraoperative LLOC. One patient (0.005%) required hospital transfer or hospitalization. Supplemental oxygen administration (obesity versus normal weight: obese I, aOR 0.52, 95% CI 0.12–2.27; II/III, aOR 1.51, 95% CI 0.50–4.54), low intraoperative LLOC, and anesthesia-related adverse events were not associated with obesity. The rate of reversal agent administration was lower among obese I, II and III women combined compared to normal weight women (aOR 0.13, 95% CI 0.02–0.96). ConclusionsAdverse outcomes were rare across all BMI categories with no detectable increased risk among obese women compared to normal weight women. ImplicationsWith appropriate clinical screening, obese women can safely receive moderate intravenous sedation for first trimester surgical abortion in an outpatient clinical setting. Restrictions on moderate intravenous sedation based on BMI alone may be unnecessary.
Highlights
926,200 abortions were performed in the United States in 2014, with 89%occurring within the first 12 weeks gestation and 95% in an outpatient setting [1, 2]
We conducted a retrospective cohort study of all first trimester surgical abortion procedures performed with moderate IV sedation at Planned Parenthood League of Massachusetts (PPLM) Health Centers in Boston, Springfield, and Worcester between
We sought to determine if obese I, II and III women experienced increased adverse outcomes with moderate IV sedation during first trimester surgical abortion compared to normal weight women
Summary
926,200 abortions were performed in the United States in 2014, with 89%occurring within the first 12 weeks gestation and 95% in an outpatient setting [1, 2]. 926,200 abortions were performed in the United States in 2014, with 89%. As of 2010, 31.9% of women between the ages of 20 to 39 in the United. Abortion among overweight or obese women in the United States is common. Pain management options for surgical abortion include local anesthesia, oral, moderate, or deep sedation, and general anesthesia [6, 7]. While deep sedation and general anesthesia provide the greatest analgesia, with these options patients are not arousable, sometimes require airway support and require monitoring by anesthesia professionals, limiting their availability in the outpatient setting [8]. With moderate intravenous (IV) sedation patients continue to respond purposefully to verbal or tactile stimulation and have better pain control and satisfaction compared to local anesthesia alone or in combination with oral sedation.
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