DILATION AND CURETTAGE (D&C)

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Dilation and Curettage (D&C) is a common gynecological procedure that involves dilating the cervix to access and scrape the lining of the uterus.

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Here's a more detailed description of the procedure:

1. Dilation: This step involves gradually opening the cervix, which is the lower part of the uterus that leads into the vagina. This is usually accomplished with the use of a series of gradually larger dilators.

2. Curettage: After dilation, a tool called a curette is inserted into the uterus. This tool can be either sharp, having a knife-like edge, or blunt. It is used to scrape or suction the lining of the uterus (endometrium). The collected tissue can then be sent for laboratory analysis if needed.

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D&C can serve several purposes. It is often used to diagnose or treat abnormal uterine bleeding. The tissue collected during a D&C can be examined for causes of bleeding such as polyps, endometrial hyperplasia, or uterine cancer. It's also commonly used to clear the uterus after a miscarriage, abortion, or to remove molar pregnancies.

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Dilation, Suction, and Curettage (D&C) is a procedure that is used in various circumstances, such as in the management of miscarriages, to treat heavy menstrual bleeding, or to obtain samples of tissue for further testing. 

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                                                 Anesthetic Implications for Dilation and Curettage (D&C)

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Anesthesia type:  General, MAC, neuraxial, or regional

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Airway: ETT or LMA

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Preoperative:

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• Full stomach precautions for pregnant patients more than 16 weeks

• Anxiolysis for emotional distress

• Consider having Oxytocin (Pitocin), Methylergonovine (Methergine), and/or Carboprost (Hemabate) available

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Intraoperative:

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• Anticipate a vasovagal response with traction on the uterus (bradycardia and decreased cardiac output)

• The further along the pregnancy, the greater the possibility of blood loss

• Dilation of the cervix is very stimulating

• May encounter hemodynamic instability due to uterine bleeding

• Possibility of sepsis from retained products of conception

• Position: Lithotomy (slight trendelenburg)

• Duration 5-20 minutes

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Postoperative:

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• PONV prophylaxis

• Pain management

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Complications:

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• Uterine perforation

• Bleeding

• Cervical laceration

• Infection

• Peroneal nerve injury

• Vasovagal response

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Sources:

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Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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