title: Anaesthesia for foetoscopic Laser ablation- a retrospective study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Foetoscopic procedures can be done under central neuraxial block, however occasionally general anaesthesia may be required.
authors.affiliation: Department of Anaesthesiology, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: Vaishali
authors.initials: V
authors.lastname: Kumbhar
authors.affiliation: Department of Anaesthesiology, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Radhika
authors.affiliation: Department of Anaesthesiology, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: Parameswara
authors.initials: P
authors.lastname: Gundappa
authors.affiliation: Department of Anaesthesiology, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: Jayashree
authors.initials: J
authors.lastname: Simha
authors.affiliation: Department of Fetal Medicine, Manipal Hospital, Bengaluru, Karnataka, India.
authors.forename: Prathima
authors.initials: P
authors.lastname: Radhakrishnan
keywords: Foetoscopic LASER ablation; twin reversed arterial perfusion syndrome; twin-to-twin transfusion syndrome