TY - JOUR T1 - Moderate (conscious) sedation in abortion care JF - BMJ Sexual & Reproductive Health JO - BMJ Sex Reprod Health DO - 10.1136/bmjsrh-2021-201380 SP - bmjsrh-2021-201380 AU - Cerés Hammenga AU - David Craig AU - Patricia A Lohr Y1 - 2021/12/23 UR - http://jfprhc.bmj.com/content/early/2021/12/22/bmjsrh-2021-201380.abstract N2 - Key messagesOperator-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.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.Staffing, procedural steps, eligibility and competency-based training were informed by the Academy of Medical Royal Colleges … ER -