General anesthesia for endoscopic laser for severe TTTS is associated with increased risk of adverse maternal outcome

WITH INCREASED RISK OF ADVERSE MATERNAL OUTCOME GREG RYAN, CRAIG PENNELL, FAWAZ ALKAZALEH, GARETH SEAWARD, JENNY PORTER, SHARON DAVIES, RORY WINDRIM, University of Toronto, Obstetrics & Gynaecology, Toronto, Ontario, Canada, University of Western Australia, Women’s and Infants’ Health, Perth, Western Australia, Australia, Mount Sinai Hospital, Toronto, Ontario, Canada, Fetal Medicine Unit, Mount Sinai Hospital, Toronto, Ontario, Canada, Mount Sinai Hospital, Obstetrics and Gynecology, Toronto, Ontario, Canada OBJECTIVE: To evaluate 3 anaesthesia techniques general (GA), epidural (ED) and conscious sedation (CS) employed for the first 80 cases of laser for severe TTTS. STUDY DESIGN: Data were abstracted from clinical records: major and minor maternal complications and fetal outcomes were compared for all techniques. Univariate comparisons were made using one-way ANOVA and Fisher’s exact tests. Multivariate logistic regression was used to identify independent associations with major maternal adverse outcomes. RESULTS: 18 cases were done under GA, 4 under ED and 58 under CS. There was no difference in maternal demographic data between groups. The GA group recorded lower systolic pressures, increased requirements for pressure therapy (p!0.01) and increased intra-operative intravenous fluids (all p!0.02). Major maternal complications (n=13) were more common with GA as compared to the other groups (p!0.01). GA remained independently associated with major maternal complications in multivariate analysis (adjusted OR 36; p=0.03) after controlling for covariates. Pulmonary edema within 24 hrs of the procedure occurred in 8 women, total IV fluid volume was the only factor independently associated with the development of pulmonary edema (adjusted OR 4.5 for each 1000 mL increase in IV fluid). CONCLUSION: GA was associated with increased risk of major maternal complications, particularly pulmonary edema, when compared to ED and CS.