title: Maternal and fetal safety of fluid-restrictive general anesthesia for endoscopic fetal surgery in monochorionic twin gestations.
abstract: OBJECTIVE
  To review our experience with general anesthesia in endoscopic fetal surgery for twin-to-twin transfusion syndrome (TTTS), and to compare fetomaternal outcome before and after protocol implementation.
  
  
  METHODS
  Retrospective impact study.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  Data from 85 consecutive patients who underwent endoscopic laser ablation of placenta vessels for severe TTTS were studied. Outcomes were compared in patients before (2000-2007) and after (2008-2012) a change to strict intraoperative intravenous (IV) fluid and liberal vasopressor management. Perioperative parameters (IV fluid administration, vasopressor use, maternal hemoglobin [Hb] concentration); maternal complication rate (respiratory, hemorrhagic); pregnancy outcome; and fetal and neonatal survival were recorded.
  
  
  RESULTS
  Patients in the early group (2000-2007; n = 55) received 1634 ± 949 mL of crystalloid fluid intraoperatively, compared with 485 ± 238 mL (P < 0.001; Student's t test) given to the late group (2008-2012; n = 30). Maternal pulmonary edema and any respiratory distress were seen in 5.5% and 12.7% of patients in the early group, respectively, and in none of the late group patients (P < 0.05; Chi-square analysis).
  
  
  CONCLUSIONS
  A significant risk of maternal respiratory complications exists after general anesthesia for endoscopic fetal surgery. Judicious fluid management significantly decreases this risk.
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Division of Pediatric Surgery, Hasbro Children's/Rhode Island Hospital, Providence, RI 02903, USA.
authors.forename: Vincent D
authors.initials: VD
authors.lastname: Duron
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Watson-Smith
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Department of Anesthesiology, Hasbro Children's/Rhode Island Hospital, Providence, RI 02903, USA; Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Benzuly
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Division of Pediatric Surgery, Hasbro Children's/Rhode Island Hospital, Providence, RI 02903, USA; Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Muratore
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI 02905, USA; Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Barbara M
authors.initials: BM
authors.lastname: O'Brien
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Division of Maternal-Fetal Medicine, Women & Infants Hospital of Rhode Island, Providence, RI 02905, USA; Alpert Medical School of Brown University, Providence, RI 02912, USA.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Carr
authors.affiliation: Fetal Treatment Program of New England, Providence, RI 02903, USA; Division of Pediatric Surgery, Hasbro Children's/Rhode Island Hospital, Providence, RI 02903, USA; Alpert Medical School of Brown University, Providence, RI 02912, USA. Electronic address: Francois_Luks@brown.edu.
authors.forename: Francois I
authors.initials: FI
authors.lastname: Luks
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D005332:Fetoscopy / Q000009:adverse effects / Q000379:methods*; D005333:Fetus / Q000601:surgery; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D010920:Placenta / Q000098:blood supply; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology; D011256:Pregnancy Outcome; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
keywords: Fetal surgery; Fetoscopy; Pregnancy; Twin-to-twin transfusion syndrome