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ANAESTHESIA
FOR EVACUATION OF RETAINED PRODUCTS OF CONCEPTION (ERPC)
Removal of retained products in the uterus is a semi-urgent
procedure because puerperal sepsis rapidly takes hold, with
potentially fatal consequences. In a busy maternity unit, there
are often many cases to deal with each day: women who have
aborted, often with established infection, and mothers with
retained products.
Ideally, the method of anaesthesia should avoid the use of
volatile agents, because they may produce uterine relaxation
and excessive bleeding. This is especially true when evacuations
are performed in septic cases, when the uterus is bulky or when
the patient has bled a lot already:
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A
total intravenous anaesthetic technique (TIVA) is ideal,
using ketamine 2– 4 mg/kg; this drug also has
oxytocic properties |
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Give
diazepam 5 –10 mg intravenously pre-induction
to settle the patient and to avoid hallucinations postoperatively |
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Alternative
TIVA methods are:
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Pethidine
50 mg IV followed by increments of thiopental
2.5% up
to a maximum dose of 500 mg |
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Or |
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Incremental
propofol, 20–30 ml. |
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Oxytocin
may be required by infusion postoperatively, 20– 40
units in 1 litre normal saline.
Clinical circumstances may lead to evacuations being done with diazepam (10
mg) and pethidine (50 mg), but many patients will not tolerate this method
and the consequent movements mean that an incomplete evacuation is carried out.
To avoid this situation, ketamine is the method of choice.
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