Dilation And Curettage (D&C)
Updated On: December 2, 2024
Anesthetic Approaches
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.
Trendelenburg Position (general considerations): Take precautions for upper airway obstruction or stridor. Avoid excessive fluid administration. OG tube is a good consideration to empty the contents of the stomach. Regurgitation of stomach contents can ulcerate the airway and/or damage the eyes. Consider throat packs and/or eye lubrication to further protect the patient. Brachial nerve injury is also a strong possibility. Be very careful with head and shoulder brace positioning. Peroneal nerve injury is a strong possibility if the patient is also in the lithotomy position. Make sure pressure points are padded. If there's peroneal nerve damage, it will manifest as foot drop. Increased IOP. Take precaution with patients that have glaucoma. Conjunctival swelling will sometimes be irritating to the patient post-operatively. Keep reminding the patient not to rub their eyes. Increased ICP. Cerebral perfusion pressure = MAP-ICP. Make sure you keep the MAP up.
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