Conscious Sedation for Surgical Abortion

Conscious sedation is a combination of medications that can be administered to make patients feel more comfortable during outpatient clinic procedures, including surgical abortion. The medications used are an anesthetic to block pain and a sedative that helps the patient relax, yet remain awake. Conscious sedation, which used to be known as “twilight sleep,” is typically administered by mouth or intravenously (IV) and can help individuals to feel relaxed through their procedure.

Who needs conscious sedation?

Surgical abortion uses suction to remove the pregnancy from the uterus and can cause moderate to strong cramping. Differences in pain tolerance, the pregnancy’s gestation and other personal circumstances may cause some patients to feel more discomfort during a surgical abortion than others.

Surgical abortions can be performed without any sedation, and we provide ibuprofen and local anesthetic injections with all procedures. However, conscious sedation does decrease pain, discomfort and anxiety during the procedure and many patients do choose this option. If the patient chooses to receive sedation, they will need to have someone drive them home since their ability to react quickly can be impaired for several hours.

How does conscious sedation work?

According to the American Society of Anesthesiologists, sedation is classified into three levels: minimal, moderate and deep sedation. Conscious sedation is a minimal to moderate sedation in which the patient may be drowsy and fall asleep, but wakes up easily. In contrast, deep sedation is when the patient is asleep throughout the procedure, will not remember any of the procedure, and requires monitoring by an anesthesiologist.

Conscious sedation differs from complete anesthesia (deep sedation) in that patients do not experience a complete loss of consciousness and are capable of breathing on their own. We do not offer complete anesthesia because it suppresses a patient’s ability to breathe, and cannot be safely managed for an in-office procedure.

Under optimal conscious sedation for surgical abortion, the patient will:

• Remain conscious, cooperative and able to respond to verbal instructions.
• Retain the ability to swallow, gag (protective reflex) and breathe on their own.
• Be comfortable and experience less anxiety.
• Have a minimal change in vital signs (heart rate, blood pressure and rate of breathing).
• Experience an acceptable amount of pain relief.
• Recover safely and quickly to their pre-procedure condition.

In advance of the procedure, our physician will discuss the details and check to make sure the patient is not allergic to the sedative for relaxation and the anesthetic used for pain. The physician will discuss medications the patient may be taking as well as level of alcohol and drug use. The physician will instruct the patient on taking current medications before the procedure, as well as discuss eating, drinking and smoking before the surgical abortion with conscious sedation.

The doctor will administer the sedative in advance of performing the procedure to ensure that it takes effect before the procedure begins. The sedative should make patients feel more relaxed or even a little drowsy. Patients who have received conscious sedation will remain awake and responsive through the procedure and may still be able to feel the procedure.

Our doctors and staff monitor patients closely through the whole procedure and recovery. For instance, during conscious sedation the patient may receive oxygen due to the sedation’s effect, and blood pressure medications may be given if sedation affects the woman’s blood pressure. Though they tend to wear off quickly, patients who opt to take sedatives must have a ride home. We recommend a person of trust such as a friend, partner, or family member. The patient may not use a rideshare service (such as Lyft or Uber) or take a taxi after receiving sedation for their procedure. If you do not have a ride home and wish to receive sedation, please let us know prior to your appointment so we can try to arrange alternate transportation for you.

Side effects of conscious sedation may include headache, nausea, feeling sleepy and having a brief period of amnesia about the procedure.