General vs local anesthesia for the percutaneous laser treatment of twin-twin transfusion syndrome

Objective The purpose of this study was to review our anesthetic experience in selective laser photocoagulation of communicating vessels (SLPCV) to treat twin-twin transfusion syndrome (TTTS). Study Design A total of 266 consecutive eligible patients were studied. Twenty-seven patients (10%) underwe...

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Bibliographic Details
Published in:American journal of obstetrics and gynecology 2008-08, Vol.199 (2), p.137.e1-137.e7
Main Authors: Rossi, A. Cristina, MD, Kaufman, Marc A., MD, Bornick, Patricia W., RN, MSN, Quintero, Rubén A., MD
Format: Article
Language:English
Subjects:
Adult
Anesthesia
Anesthesia, General
Anesthesia, Local
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Conscious Sedation
Female
fetal outcome
Fetofetal Transfusion - surgery
general anesthesia
General anesthesia. Technics. Complications. Neuromuscular blocking. Premedication. Surgical preparation. Sedation
Gynecology. Andrology. Obstetrics
Heart Rate
Hematocrit
Hemoglobins - analysis
Humans
Hypertension - epidemiology
Intraoperative Period
Laser Coagulation
local anesthesia/conscious sedation
Maternal Age
maternal outcome
Medical sciences
Obstetrics and Gynecology
Pregnancy
Pregnancy Outcome
twin-twin transfusion syndrome
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Summary:Objective The purpose of this study was to review our anesthetic experience in selective laser photocoagulation of communicating vessels (SLPCV) to treat twin-twin transfusion syndrome (TTTS). Study Design A total of 266 consecutive eligible patients were studied. Twenty-seven patients (10%) underwent general anesthesia (GenA), 100 (38%) received total intravenous anesthesia (TIVA), and 139 (52%) received local anesthesia/conscious sedation (LocA). Maternal-fetal hemodynamic fluctuations were compared between groups. Results Maternal blood pressure decreased significantly in all 3 groups during surgery ( P < .0001) but was more evident in the GenA and TIVA groups ( P < .0001). Maternal heart rate varied significantly in GenA ( P = .02) but was constant in LocA and TIVA. There were no significant differences in fetal heart rate changes between the groups. Intraamniotic bleeding occurred more frequently with GenA and TIVA than LocA( P < .0001). Conclusion Local anesthesia is the safest anesthetic technique for SLPCV in TTTS patients.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2007.12.008