34. Entonox Sedation For IUD insertion In Adolescents - A pilot Project

Abstract

Background

The use of inhaled Entonox is a novel approach to providing patient-controlled sedation for an IUD insertion. Entonox sedation can be use in a clinic situation without the need for IV or Anesthetists. The tanks are portable and can refilled and the masks are inexpensive to purchase.

Methods

16 subjects were recruited for IUD insertion with patient-controlled Entonox. Informed consent for an IUD insertion and pilot study was obtained. Subjects were included with the following: age greater than 15, BMI less than 30, Patient has had failed attempts at IUD insertion in the clinic or it has been determined through patient assessment that sedation is required to support insertion. Developmentally able to self-administer Entonox. Exclusion criteria included: Patients less than 15, existence of co-morbidities, experienced sexual trauma, known anatomical concerns. Pregnancy tests were performed prior to insertion and routine vaginal swabs taken at time of insertion. Insertions took place in induction rooms and in outpatient clinics. Each patient received a satisfaction survey following insertion using a QR code in Redcap. IRB approval was obtained.

Results

16 patients were consented and 100% of them had an IUD successfully inserted under patient-administered Entonox in a clinic setting. The satisfaction survey revealed a satisfaction rate of 90% (range 7-10). 10/16 (62.5%) responded to the redcap survey. The patient's perception of success was 86% range (5-10).

Conclusions

Entonox patient-administered sedation is an excellent option for insertion of IUD in adolescents. This method allows sedation in a clinic setting and will significantly reduce the demands on expensive resources such as OR time or anesthesia lead procedural rooms. As this is a pilot study numbers are small, only 16 patients, and we recommend confirming outcomes with a larger cohort. Entonox patient-administered anesthesia could also be expanded to support IUD insertions in the adult clinics.