Position: Supine, Lithotomy
Time: 30-60 min (short)
Blood Loss: High (200 – 500 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No

PONV prophylaxis – Most of these patients will be relatively young and female, which will predispose them to PONV. Give the full range of PONV prophylaxis.

Bleeding – Many of these patients will be having an aborted fetus surgically removed. When the placenta is removed, there’s a much higher possibility for bleeding. Anticipate orders from the surgeon:

Oxytocin (Pitocin): 10-30 units is common (should be added to a 1L bag and run wide open)
Methylergonovine (Methergine): 0.2 mg IM
Carboprost Tromethamine (Hemabate): 250 mcg IM

Oxytocin note – Never give IV push as it can cause significant hypotension

Positioning – After induction, the patient is placed in the lithotomy position and the bed is raised to about the height of the surgeon’s head. The surgeon will sit between the patient’s legs. Many times, the surgeon will request a slight trendelenburg to optimize the view of the cervix and uterus.

Dilation of the cervix is very stimulating – so administration of a narcotic or ketamine is typically warranted a 3-5 minutes prior. This is titrated as the procedure moves to curettage, etc.

MAC approach – in some cases, a MAC approach is used for these procedures. The approach is done by utilizing a heavy dose propofol drip and multimodal adjuncts (precedex, versed, fentanyl). The surgeon may do a cervical block as well.

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

This procedure is sometimes done to explore the area and rule out morbidities. In most cases, if something is found the surgeon will proceed to surgical excision, etc.

In other cases, this procedure may be utilized to remove a nonviable fetus (suction and curettage)

Dilation is the opening of the cervix (opening of the uterus), and curettage is scraping of the uterus.

Use of Ketamine – Many suggest that the use of Ketamine is especially useful because these patients are extremely emotional due to the circumstances surrounding the D&C. 10 mg – 0.5 mg/kg has been recommended.