Anesthésie pour interruption médicale de grossesse

Due to the development of prenatal diagnosis, the incidence of termination of pregnancy has increased. Most of the procedures occur during the second and the third trimester of pregnancy and require a more painful and longer duration protocol than endometrial scraping. Late terminations are comparable to obstetrical induced labor (by intravaginal and oral misoprostol) and most of the time augmented (by intravenous ocytocin). Physical pain is combined to psychological suffering. Anesthesiologists play a key role in managing these patients with analgesic techniques comparable to the ones used for delivery. Epidural analgesia is the most effective analgesic technique that can be used for feticide and retained placenta requiring uterine scrapping. Local anesthetic requirement is more important than for normal delivery. Clonidine could be a useful adjuvant, but it is not commonly used. Epidural analgesia is not always possible due to maternal refusal or haemostasis disorders (after fetal death) or chorioamniotic infection. Patient-controlled intravenous analgesia with remifentanil is an alternative. It requires a careful monitoring of parturients for respiratory depression. Sedative and anxiolytic agents are commonly used. Alpha-2 delta agonists (pregabalin) may be more effective than benzodiazepines in this setting.