title: [Two cases of congenital airway obstruction managed with ex utero intrapartum treatment procedures: anesthetic implications].
abstract: An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.
authors.affiliation: Servicio de Anestesiología y Reanimación, Area Materno-Infantil. Hospital Universitario Vall d'Hebron, Barcelona. smanriquemu@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Manrique
authors.forename: J
authors.initials: J
authors.lastname: Blasco
authors.forename: F
authors.initials: F
authors.lastname: Munar
authors.forename: E
authors.initials: E
authors.lastname: Andreu
authors.forename: M D
authors.initials: MD
authors.lastname: Mateo
authors.forename: M C
authors.initials: MC
authors.lastname: Suescun
authors.forename: M V
authors.initials: MV
authors.lastname: López Gil
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000151:congenital* / Q000601:surgery; D000769:Anesthesia, Inhalation; D000773:Anesthesia, Obstetrical / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000494:pharmacology; D002585:Cesarean Section; D005260:Female; D006258:Head and Neck Neoplasms / Q000150:complications / Q000151:congenital / Q000601:surgery*; D006801:Humans; D020883:Hysterotomy; D007231:Infant, Newborn; D007442:Intubation, Intratracheal; D008738:Methyl Ethers / Q000008:administration & dosage / Q000494:pharmacology; D008755:Methylergonovine / Q000494:pharmacology / Q000627:therapeutic use; D009959:Oropharyngeal Neoplasms / Q000150:complications / Q000151:congenital / Q000601:surgery*; D010121:Oxytocin / Q000494:pharmacology / Q000627:therapeutic use; D021041:Placental Circulation; D006831:Polyhydramnios; D011247:Pregnancy; D000077149:Sevoflurane; D013724:Teratoma / Q000150:complications / Q000151:congenital / Q000601:surgery*; D014139:Tracheostomy; D014590:Uterine Contraction / Q000187:drug effects
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D010121:Oxytocin; D008755:Methylergonovine