Anesthesia

1.   Overview:  Anesthesia for abortion can consist of local numbing medicines in the cervix or uterus and/or generalized/systemic medications that travel through the blood to affect pain, relaxation and consciousness.  There are three levels of systemic anesthesia that are classified by the patient’s response to the medications.

2.   Local analgesia

a.    Cervical or paracervical blocks, or intrauterine analgesia: For most abortions, medication is injected into the cervix to alleviate pain associated with the application of a tenaculum to the cervix and with cervical dilatation.  This has some effect on uterine pain as well.  Far less commonly, medication also is instilled or injected in the uterus.  Most North American providers use 1% lidocaine.

3.    Systemic Anesthesia

a.    Level 1 – Minimal sedation:  A drug-induced state during which patients respond normally to verbal commands and can understand and answer questions.   Although mental function and coordination may be impaired, breathing and heart functions are unaffected.   Typical medications for minimal sedation, usually taken orally or sublingually, include benzodiazepines such as lorazepam and/or narcotic combinations such as acetaminophen and hydrocodone (Vicodin).

b.    Level 2 – Moderate, or “conscious” sedation:  A minimally depressed level of consciousness that retains the patient’s ability to breathe independently, to be aroused easily, and to respond appropriately to physical stimuli and verbal commands.   Medications usually are given through an intravenous catheter in the arm.   Typical medications for moderate sedation include fentanyl and midazolam.

c.    Level 3/4 – Deep sedation/General anesthesia:  A controlled state of depressed consciousness from which the patient is not easily aroused.   An anesthesiologist (e.g., MD anesthetist or Certified Registered Nurse Anesthetist, or CRNA) usually administers this level of anesthesia.