OFFICE BASED PROPOFOL SEDATION FOR TERMINATION OF PREGNANCY (TOP) IN ASA I AND II WOMEN: MORTALITY, SERIOUS INCIDENTS AND INCIDENTS IN 65.460 PATIENTS.
Catherine J. De Jong, anesthesiologist, member advisory board Beahuis & Bloemenhovekliniek, Heemstede, Netherlands

Background & Objectives: Termination of pregnancy (TOP) is a medical procedure that can be done under local anesthesia. Most women prefer sedation during the procedure. In a group of 8 Dutch abortion clinics sedation is given by well-trained physicians (not by anesthesiologists but by specialized TOP physicians) and nurses.
Objectives: To evaluate safety and complications of the sedation method used: pre-treatment screening by physician, propofol sedation combined with low dose alfentanil (maximum 1mg), supplemented with local anesthesia by abortion physician, for TOP in 8 specialized office based abortion clinics.
Materials & Methods: Retrospective descriptive study of 87.347 patient records (2010–2015). Patients were screened prior to treatment by the physician. ASA I and II patients were accepted for sedation. Records were kept (ECG, NIBP, Breathing Rate, SaO2). Serious incidents (lasting damage to patient) and incidents (no lasting damage to patient) due to sedation were recorded.
Results: Total number of patients: 87.347. Procedures done without sedation (abortion pill or instrumental procedure under local anesthesia only): 21.887 patients. Local anesthesia combined with sedation: 65460 patients. A total of 87 incidents were reported.
Serious incidents: deaths 0, resuscitations 0, ambulance transport to hospital 0, vomiting & aspiration 0, anaphylactic reactions 0.
Incidents: desaturation (SaO2>80% and<5min) 19(0,03%), desaturation (SaO2<80% or/and>5min) 9 (0,014%), desaturation and laryngeal mask used 1, desaturation and mask ventilation for few minutes 1, desaturation and intubation needed 0, laryngospasm/bronchospasm/stridor 6, coughing/excessive sputum/suction needed 5, vomiting 2, rash 7, subcutaneous propofol 18 (0,03%), bradycardia +/- atropine given 6, yawning & jaw luxation 2, hyper salivation & atropine given 1, nerve touched during insertion of IV 1, extreme restlessness at waking up 7, myoclonic movements at induction 2. No or interrupted sedation due to incident 3.
Conclusion: This review indicates that office based ambulatory propofol sedation with a maximum of 1mg alfentanil for TPO in ASA I and II women provided by TOP physicians is safe and with a very low risk of serious incidents.

Office based propofol sedation for Termination of Pregnancy (TOP) in ASA I and II women: mortality, serious incidents and incidents in 65.460 patients