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Indian J Anaesth. 2016 Dec;60(12):931-935. doi: 10.4103/0019-5049.195486.

Anaesthesia for foetoscopic Laser ablation- a retrospective study.

Author information

  • 1Department of Anaesthesiology, Manipal Hospital, Bengaluru, Karnataka, India.
  • 2Department of Fetal Medicine, Manipal Hospital, Bengaluru, Karnataka, India.

Abstract

BACKGROUND AND AIMS:

Twin pregnancy with monochorionic placenta may be associated with arteriovenous vascular anastomosis of the placental vessels resulting in twin-to-twin transfusion syndrome (TTTS) and twin reversed arterial perfusion syndrome (TRAP). Foetoscopic LASER ablation (FLA) is the treatment of choice in reducing foetal mortality related to this.

METHODS:

A retrospective review of medical records of 41 FLA procedures for TTTS and TRAP were analysed for anaesthetic management. Thirty-four patients received subarachnoid block, three combined spinal-epidural block, three general anaesthesia and one local anaesthesia with sedation. Nitroglycerine 5 mg patch was used for tocolysis 1 h before the procedure and continued for 24-48 h postoperatively.

RESULTS:

Bupivacaine was used in 34 patients, and ropivacaine in three patients. Mean dose of bupivacaine 0.5% was 2.43 ± 0.32 ml and ropivacaine 0.75% was 2.85 ± 0.19 ml. The mean duration of surgery was 117.07 ± 28 min. Mild hypotension occurred in all patients under spinal anaesthesia and was treated with vasopressors. The foetal outcome among all 41 patients were 13 delivered live twins, 15 had a single live baby with intrauterine death of other twin baby. In 12 patients, both babies were intrauterine death. One patient was lost for follow-up.

CONCLUSION:

Foetoscopic procedures can be done under central neuraxial block, however occasionally general anaesthesia may be required.

KEYWORDS:

Foetoscopic LASER ablation; twin reversed arterial perfusion syndrome; twin-to-twin transfusion syndrome

PMID:
28003695
PMCID:
PMC5168896
DOI:
10.4103/0019-5049.195486
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