Background and Aims:Twin pregnancy with monochorionic placenta may be associated with arteriovenous vascular anastomosis of the placental vessels resulting in twin-to-twin transfusion syndrome (TTTS) and twin reversed arterial perfusion syndrome (TRAP). Foetoscopic LASER ablation (FLA) is the treatment of choice in reducing foetal mortality related to this.Methods:A retrospective review of medical records of 41 FLA procedures for TTTS and TRAP were analysed for anaesthetic management. Thirty-four patients received subarachnoid block, three combined spinal-epidural block, three general anaesthesia and one local anaesthesia with sedation. Nitroglycerine 5 mg patch was used for tocolysis 1 h before the procedure and continued for 24–48 h postoperatively.Results:Bupivacaine was used in 34 patients, and ropivacaine in three patients. Mean dose of bupivacaine 0.5% was 2.43 ± 0.32 ml and ropivacaine 0.75% was 2.85 ± 0.19 ml. The mean duration of surgery was 117.07 ± 28 min. Mild hypotension occurred in all patients under spinal anaesthesia and was treated with vasopressors. The foetal outcome among all 41 patients were 13 delivered live twins, 15 had a single live baby with intrauterine death of other twin baby. In 12 patients, both babies were intrauterine death. One patient was lost for follow-up.Conclusion:Foetoscopic procedures can be done under central neuraxial block, however occasionally general anaesthesia may be required.

BACKGROUNDExophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumour). Measurement of the degree of exophthalmos is performed using an exophthalmometer. Most sources define exophthalmos/ proptosis as a protrusion of the globe greater than 18 mm. The objectives of this study were 1. to determine the incidence of proptosis and the various etiological factors causing proptosis 2. to know common causes of proptosis among different age groups. MATERIALS AND METHODSA prospective analysis of 50 cases of proptosis was done over a period of 2 years. Detailed ocular and systemic history, examination and relevant investigations were done in necessary cases and also other departments' opinions were taken where ever required for diagnosis and treatment. RESULTSIncidence of proptosis was found to be more common in patients above 50 yrs. of age. Incidence of proptosis was noted to be more common in males than females. Right eye was affected in 25 cases, left was affected in 20 cases and bilateral involvement seen in 5 cases. Majority of cases were found to have axial proptosis-34 out of 50 cases. Most cases of orbital cellulitis, proptosis due to retinoblastoma and pseudotumour presented with axial proptosis. Fundus examination revealed disc oedema in 2 cases, optic atrophy in 3 cases. Radiological investigations revealed positive radiological evidence in 25 cases. The positive radiological findings were soft tissue shadow, expansion of orbit, dehiscence of bone, erosion of bone, enlargement of optic foramen or destruction of optic foramen. No congenital case of proptosis was seen. Primary orbital tumours accounted for 6% of cases and were adenoid cystic carcinoma of lacrimal gland, eosinophilic granuloma and osteoma. Secondary orbital tumours accounted for 28% of cases; out of these 24% were due to retinoblastoma, 18% were due to paranasal sinuses. Metastatic orbital tumours accounted for 6%; leukaemia, and carcinoma breast and lung, 2 cases of retrobulbar haematoma was diagnosed. CONCLUSIONSecondary orbital tumours were found to be the most common cause of proptosis in this study. Investigative modalities like X-Ray, B-Scan, CT Scan, and MRI were very helpful in diagnosis treatment and follow up.

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