[Comparison between Dexmedetomidine and Fentanyl Infusion during Fetoscopic Laser Photocoagulation for Twin to Twin Transfusion Syndrome].

Abstract

Background: Fetoscopic laser coagulation is an ef- fective treatment for the vascular anastomoses present in twin to twin transfusion syndrome (TTTS); how- ever, anesthetic management during the procedure has not yet been standardized. We hypothesized that dex- medetomidine could produce excellent maternal seda- tion during fetoscopic surgery. Therefore, we per- formed a prospective study to compare dexmedetomi- dine with fentanyl infusion, which had been previously used for sedation.

Methods: Patients scheduled for fetoscopic laser coagulation for TTTS were randomized into 2 groups. In the first group (n =19), fentanyl (2 μg · kg-1) was intravenously infused, followed by a maintenance dose of 1-2,μg · kg⁻¹ · hr⁻¹. The second group (n=18) received a loading dose of dexmedetomidine (1 μg · kg⁻¹) for 10 min, followed by a maintenance dose of 0.7 μg · kg⁻¹ · hr⁻¹. Both groups received 1% lidocaine administered locally. Adverse event incidence, hemo- dynamic parameters, and face scale were evaluated.

Results: One patient in the dexmedetomidine group required conversion to general anesthesia. Vomiting, nausea, and respiratory depression were significantly more frequent with fentanyl than with dexmedetomi- dine. Face scale scores were significantly better with dexmedetomidine than with fentanyl.

Conclusions: Continuous dexmedetomidine infusion provides acceptable maternal analgesia and sedation during endoscopic treatment of TTTS.