Anaesthesia for foetoscopic Laser ablation- a retrospective study.

Area of Science:

• Maternal-Fetal Medicine
• Surgical Anesthesiology
• Perinatology

Background:

• Monochorionic twin pregnancies can develop arteriovenous vascular anastomoses, leading to twin-to-twin transfusion syndrome (TTTS) and twin reversed arterial perfusion syndrome (TRAP).
• Foetoscopic LASER ablation (FLA) is the primary treatment to reduce fetal mortality in these conditions.

Purpose of the Study:

• To analyze the anesthetic management and outcomes of foetoscopic LASER ablation (FLA) procedures for TTTS and TRAP.
• To evaluate the safety and efficacy of different anesthetic techniques in patients undergoing FLA.

Main Methods:

• Retrospective review of 41 FLA procedures for TTTS and TRAP.
• Analysis of anesthetic management, including subarachnoid block, combined spinal-epidural block, and general anesthesia.
• Use of nitroglycerine patches for tocolysis pre- and post-procedure.

Main Results:

• Subarachnoid block was the most common anesthetic technique (34 patients).
• Mild hypotension occurred in all spinal anesthesia patients, managed with vasopressors.
• Fetal outcomes varied: 13 delivered live twins, 15 had one live baby and one intrauterine death, and 12 had both intrauterine deaths.

Conclusions:

• Foetoscopic procedures for TTTS and TRAP can be safely performed under central neuraxial blockade.
• General anesthesia may be required in select cases.
• Anesthetic management should be tailored to individual patient needs and procedural requirements.