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Better way of working
Moderate (conscious) sedation in abortion care
  1. Cerés Hammenga1,
  2. David Craig2,3,
  3. Patricia A Lohr3
  1. 1 Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
  2. 2 Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3 British Pregnancy Advisory Service, Stratford-upon-Avon, UK
  1. Correspondence to Dr Patricia A Lohr, British Pregnancy Advisory Service, Stratford-upon-Avon CV37 9BF, UK; patricia.lohr{at}bpas.org

https://doi.org/10.1136/bmjsrh-2021-201380

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    Key messages

    • Operator-delivered intravenous moderate (conscious) sedation is a safe and acceptable alternative to general or local anaesthesia for vacuum aspiration abortion.

    • Operator-delivered moderate (conscious) sedation in abortion care is novel in Britain; successful service implementation is aided by stakeholder engagement, local data, and training aligned with national standards.

    • Intravenous moderate (conscious) sedation may be beneficial in making other sexual and reproductive healthcare interventions provided with local or no anaesthesia more comfortable for patients.

    Why was the service needed?

    General anaesthesia (GA) for first-trimester surgical abortions is not routinely recommended due to its safety risks and financial costs.1 2 Low-dose intravenous (IV) midazolam and fentanyl to achieve a state of moderate (conscious) sedation (CS) is listed in (inter)national guidance1–4 as an alternative to GA or local cervical anaesthesia (LA) alone. During CS, depression of the central nervous system enables treatment while maintenance of verbal contact protects the airway. Oral analgesia (eg, ibuprofen) and a paracervical block are typically used alongside the IV medications. Compared with LA alone, CS is associated with greater satisfaction and lower pain scores with first-trimester surgical abortion.4 British Pregnancy Advisory Service (BPAS) provides approximately 90 000 abortions annually; 98% under National Health Service (NHS) contract. The cost of CS at BPAS was estimated to be 40% lower than GA because it does not require an anaesthetist, operating department practitioner or operating theatre with positive pressure ventilation, and requires only one stage of recovery. The ability to provide CS from a treatment room also meant more clinics could provide CS than GA, lowering financial and travel burdens for clients. We sought to implement CS to improve accessibility, safety, and cost-effectiveness of surgical abortion.

    How was the service established?

    Staffing, procedural steps, eligibility and competency-based training were informed by the Academy of Medical Royal Colleges …

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    Footnotes

    • Contributors CH and PAL conceived of the article. DC provided guidance on content. CH and PAL wrote the first draft. All authors contributed to the final draft and approved it for publication.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.