Epidural versus General Anesthesia for Twin-Twin Transfusion Syndrome Requiring Fetal Surgery
| Autor: | Laura B. Myers, Mehernoor F. Watcha |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Anesthesia
Epidural Embryology medicine.medical_specialty medicine.medical_treatment Fetofetal transfusion Anesthesia General Anastomosis Fetoscopy Pregnancy medicine Humans Radiology Nuclear Medicine and imaging Fetal therapy Twin Twin Transfusion Syndrome Retrospective Studies Laser Coagulation medicine.diagnostic_test business.industry Fetal surgery Obstetrics and Gynecology Retrospective cohort study Fetofetal Transfusion General Medicine Surgery Fentanyl Anesthesia Pediatrics Perinatology and Child Health Female business Laser coagulation Adjuvants Anesthesia |
| Zdroj: | Fetal Diagnosis and Therapy. 19:286-291 |
| ISSN: | 1421-9964 1015-3837 |
| Popis: | Objectives: This 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). Methods: Retrospective 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. Results: Patients 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. Conclusions: The 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. |
| Databáze: | OpenAIRE |
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