Pulmonary aspiration of gastric contents during deep sedation for first and second trimester abortion: a systematic...

Currently, no universally accepted standard of care exists for anesthesia management during uterine evacuation procedures, and the comprehensive risk of aspiration under deep sedation without intubation remains unclear. The main concern regarding deep sedation without intubation is the risk of pulmonary aspiration due to inadequate airway protection, especially given the physiological changes associated with pregnancy. Although intubation can mitigate this risk, it introduces its own complications such as airway injury and hypoxemia.

We conducted a systematic review following the PRISMA guidelines. Databases were searched from January 1, 2000 to April 13, 2026 to find eligible studies that evaluated patients undergoing uterine evacuation procedures under deep sedation without intubation and reported pulmonary aspiration risks.

Six retrospective, cohort studies fit the inclusion criteria. Across these studies, a total of 81,120 patients underwent a uterine evacuation procedure under deep sedation without intubation. There were a total of two cases of pulmonary aspiration reported, only one of which was aspiration of gastric contents. The most common secondary anesthesia-related adverse event was conversion to intubation which occurred in five individuals. Risk of bias across studies was determined to be fair using the National Institute of Health Quality Evaluation Tool, and the certainty of evidence was rated very low using the GRADE tool.

Deep sedation without intubation appears to be a safe approach for uterine evacuation procedures with pulmonary aspiration and other anesthesia-related adverse events reported rarely. Future prospective studies are required to identify patient-specific factors that serve as risk modifiers.