• Fetal. Diagn. Ther. · May 2004

    Comparative Study

    Epidural versus general anesthesia for twin-twin transfusion syndrome requiring fetal surgery.

    • Laura B Myers and Mehernoor F Watcha.
    • Department of Anesthesia, Children's Hospital, Harvard Medical School, Boston, MA 02115-5737, USA. laura.myers@tch.harvard.edu
    • Fetal. Diagn. Ther. 2004 May 1; 19 (3): 286-91.

    ObjectivesThis paper describes our experiences with epidural and general anesthesia for selective fetoscopic laser photocoagulation (SFLP) of placental vascular anastomoses in patients with severe twin-twin transfusion syndrome (TTTS).MethodsRetrospective review of 29 anesthetic and surgical operative records of 28 women undergoing SFLP at The Children's Hospital of Philadelphia from July 1996 to June 2001.ResultsPatients with anterior placentas were more likely to receive a general anesthetic. Patients receiving an epidural anesthetic received significantly more intravenous (i.v.) crystalloid but less i.v. fentanyl than those receiving a general or combined technique.ConclusionsThe advantages of general anesthesia include increased ability of the patient to tolerate extreme positions and the surgical manipulation of the uterus (required in the technically more difficult cases), greater uterine relaxation, decreased use of i.v. fluids, but increased fentanyl requirements. Epidural anesthesia avoids the risks of failed tracheal intubation in pregnant women but may not reduce fetal responses to surgical stimuli unless the mother receives supplemental intravenous drugs. However, this may increase the risk of respiratory depression. The choice of anesthetic technique for SFLP in patients with severe TTTS must be made after careful consideration of maternal and fetal factors.Copyright 2004 S. Karger AG, Basel

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