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).


METHODS
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).


CONCLUSIONS
Local anesthesia is the safest anesthetic technique for SLPCV in TTTS patients.
Rossi
A Cristina
AC
IV Clinic of Obstetrics and Gynecology, University of Bari, Bari, Italy.
Kaufman
Marc A
MA
Bornick
Patricia W
PW
Quintero
Rubén A
RA
D000328:Adult; D000768:Anesthesia, General; D000772:Anesthesia, Local; D016292:Procedural Sedation; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006339:Heart Rate; D006400:Hematocrit; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007432:Intraoperative Period; D017075:Laser Coagulation; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome
D006454:Hemoglobins