[Anesthesia management for fetoscopic treatment of twin-to-twin transfusion syndrome].
BACKGROUND
The fetoscopic laser coagulation of the vascular anastomoses on the monochorianic placenta for twin-to-twin transfusion syndrome (TTTS) has recently been shown to be effective. There have been few reports on the anesthetic techniques used for the fetoscopic laser coagulation. We report cases in which midazolam and fentanyl were used for the anesthetic management of the fetoscopic laser coagulation.


METHODS
Twenty-two healthy (ASA I, II) women in the second trimester of pregnancy, carrying twins and scheduled for the fetoscopic laser coagulation for TTTS, were included. Midazolam 1 mg and fentanyl 2 microg x kg(-1) were infused intravenously before insertion of urethral catheter. Thereafter, fentanyl was infused at a rate of 2 microg x kg x hr(-1) lidocaine (1%, 5 ml) was administered locally.


RESULTS
The procedure was performed successfully in 21 of 22 cases with acceptable pain. In one case, general anesthesia was necessary because the pain was not controlled. Maternal respiratory rate and end-tidal CO2 remained stable during the procedure. No patient had the respiratory rate below 10 breaths x min(-1).


CONCLUSIONS
Continuous fentanyl infusion with midazolam provided acceptable maternal analgesia and sedation during endscopic treatment of TTTS. Careful titration with simulation of fentanyl concentration and respiratory monitoring enable safe and effective anesthesia management.
Perinatal Care Center, Yamaguchi University School of Medicine, Ube.
Yasuhiro
Y
Morimoto
Manabu
M
Yoshimura
Hanayo
H
Orita
Hiroaki
H
Matayoshi
Daisuke
D
Nagamizo
Takefumi
T
Sakabe
Masahiko
M
Nakata
D000328:Adult; D000758:Anesthesia / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D008874:Midazolam / Q000008:administration & dosage; D011247:Pregnancy
D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl