Anesthesia For Surgical Abortions
Both first and second trimester surgical abortions can be performed with various types of anesthesia – local anesthesia, intravenous (IV) sedation, and general anesthesia. At the Philadelphia Women’s Center’s abortion clinic in Pennsylvania, we offer local anesthesia and IV sedation. These methods can help to control pain and discomfort during the procedure – each has benefits and risks. Your medical team will help you decide which method is best for you. While either local anesthesia or IV sedation is appropriate for a first trimester procedure, our physicians feel that IV sedation is most appropriate for most second trimester abortions and do not offer local anesthesia after a certain point in your pregnancy.
If your procedure is performed with local anesthesia you will be awake and conscious, and will be able to see, hear and feel what is happening during the abortion procedure. Because everyone is different, some women will describe the procedure as uncomfortable while others will say that it is painful. Additional oral pain medication is offered after the surgery to ease cramping and discomfort.
How it works: Your physician will inject an anesthetic called lidocaine into your cervix. Lidocaine works by blocking the nerve impulses that produce pain, numbing the area immediately surrounding the injection site. Lidocaine takes effect within a few seconds and usually lasts for 15-20 minutes. This medication will relax your cervix, but you will still experience cramping and discomfort during the procedure.
Benefits of local anesthesia: Choosing local anesthesia allows you to come to the clinic on your own. You will be able to drive or take public transportation without an escort to ensure your safety, however we always recommend bringing a support person with you if you can. Local anesthesia will also help you avoid some of the side effects and increased risks of IV sedation medicines. You also remain alert and in control during the entire procedure.
Risks and side effects: Although very rare, there is a medical risk of an allergic reaction (rash, swelling, or shock). It is important to tell us if you have ever experienced an allergic reaction to a local anesthetic before. Side effects may include dizziness, nausea, a metallic taste in your mouth, and cramping could become stronger as the anesthesia wears off.
If your procedure is performed under intravenous sedation, you will not see, hear or feel any part of the surgery, and you will not remember anything about the surgery afterwards. This type of anesthesia is administered through an IV. You will be either semi-conscious or completely asleep during the procedure, and may receive oxygen through a breathing mask. You may appear to be awake during the procedure, but will have little or no memory of the surgery. Immediate sedation and amnesia typically wear off 2-3 minutes following the procedure.
While this is a great method for women who wish to decrease pain, it is not appropriate for all women. The Center’s medical staff will talk with you about your medical history to ensure that you are able to have IV sedation safely.
How it works: If you choose IV sedation, you will receive a combination of two or three medications. Fentanyl is a narcotic analgesic that provides pain relief and sedation; Versed is a benzodiazepine (central nervous system depressant) that provides sedation and amnesia; and Diprivan is a sedative hypnotic agent that produces sedation and sleep. Additional drugs may include Droperidol, Reglan, Brevital, Atropine, and others.
Benefits of IV sedation: The greatest benefit of IV sedation is that you will not see, hear, feel or remember the surgery. It is a good option if you are particularly nervous and do not have any respiratory illness or serious medical problems.
Risks and side effects: Although rare, there is a risk of allergic reaction which may range from a rash or swelling to shock. In addition, the following risks are: prolonged unconsciousness, which can result from different rates of drug metabolism; damage to mouth and teeth, airway or vocal cords, which can occur if you aspirate (vomit) and must be intubated (tube inserted in throat to help you breathe); cardiac arrest; respiratory paralysis; hypothermia; and very rarely, death. These are the most serious complications, and can result from severe allergic reactions, aspiration, certain preexisting medical conditions, inappropriate administration and maintenance of anesthesia or other rare, unpredictable variables. Side effects include grogginess, sleepiness, nausea and vomiting, itchy skin, hyperemotionality (waking up crying or laughing), and cramping may appear to become stronger as the anesthesia effects wear off. Please be assured that licensed professionals who are specially trained in the administration of anesthesia will be taking care of you.
Restrictions: If you choose IV sedation, you cannot eat, drink, chew or smoke after midnight the night before your procedure. Heavy and greasy food should be avoided. Most women can eat a normal meal within 4-5 hours after the surgery. You must have someone to escort you home, and you may not drive or operate heavy machinery for 24 hours. In addition, you cannot have responsibility for children or dependents for the remainder of the day, so be sure to arrange for all childcare needs ahead of time.