[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.