ABSTRACT
INTRODUCTION: Fetoscopic selective laser photocoagulation (FSLPC) and selective cord occlusion with radiofrequency ablation (RFA) can improve fetal outcomes when vascular anastomoses between fetuses cause twin-to-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) in multiple gestation pregnancies with monochorionic placentation. This study analyzed perioperative maternal-fetal complications and anesthetic management in a high-volume fetal therapy center over a 4-year period. METHODS: Included patients received MAC for minimally invasive fetal procedures for complex multiple gestation pregnancies between January 1, 2015, and September 20, 2019. Maternal and fetal complications, intraoperative maternal hemodynamics, medication usage, and reasons for conversion to general anesthesia, if applicable, were analyzed. RESULTS: A total of 203 (59%) patients underwent FSLPC and 141 (41%) had RFA. Four patients (2%; rate 95% CI: 0.00039, 0.03901) undergoing FSLPC had conversion to general anesthesia. No conversions to general anesthesia occurred in the RFA group. The incidence of maternal complications was higher in those who underwent FSLPC. No aspiration or postoperative pneumonia events were observed. Medication usage was similar in FSLPC and RFA groups. CONCLUSION: A low rate of conversion to general anesthesia and no serious adverse maternal events were observed in patients receiving MAC.
ABSTRACT
BACKGROUND: Both hyponatremia and portal vein thrombosis (PVT) reflect the severity of liver dysfunction and are independently associated with increased morbidity in cirrhotic patients. In this study, we analyzed effects of hyponatremia on PVT development. METHODS: Data on adult liver transplants (LTs) in the Model for End-Stage Liver Disease era through September 2016 were obtained. Receiver operating curves and multivariable logistic regression models were constructed to evaluate the association between serum sodium level and PVT. Based on the receiver operating curves, hyponatremia was defined as a sodium level below 125 mEq/L. RESULTS: Of the 49,155 recipients included, 16% had hyponatremia (n = 7828) and 9% had PVT (n = 4414) at transplant. Subjects with hyponatremia had lower rates of PVT at the time of LT (4.4% vs 10.1%, P < .001), incidence of nonalcoholic steatohepatitis (10.8% vs 16.5%, P < .001), diabetes (19.7% vs 24.3%, P < .001), and need for dialysis (8.8% vs 16.0%, P < .001) as well as higher rates of chronic hepatitis C and B (37.6% vs 29.1%, P < .001 and 2.9% vs 1.7%, P < .001). Multivariable regression analysis confirmed that hyponatremia was independently associated with a decreased likelihood of PVT (odds ratio [OR], 0.44, P < .001). African American patients had a lower incidence of PVT (OR, 0.70; P < .001). Variables associated with a higher incidence of PVT were: nonalcoholic steatohepatitis (OR, 1.15; P = .005), moderate-to-severe ascites (OR, 1.10; P = .008), and Hispanic ethnicity (OR, 1.2; P < .001). CONCLUSION: Hyponatremia is associated with a lower rate of PVT independent of severity of liver disease and other thrombotic risk factors. This protective effect should be taken into consideration during the perioperative management of hyponatremia in patients undergoing LT.
