Dilation And Curettage (D&C)

Anesthesia Implications

Position: Lithotomy, Trendelenburg
Time: 30-60 min (short)
Blood Loss: Low (10-50 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.

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. Some recommend 10 mg – 0.5 mg/kg. This is titrated as the procedure moves to curettage, etc.

This procedure is sometimes done simply 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.

Bleeding Possibilities – not common, but the patient may bleed more than expected. In these cases, the doctor may order:

Oxytocin (Pitocin): 10-30 units is common
Methylergonovine (Methergine): 0.2 mg IM
Carboprost Tromethamine (Hemabate): 250 mcg IM