The ex utero intrapartum treatment procedure: anesthetic considerations.
The ex-utero intrapartum treatment (EXIT) procedure is an uncommon operation indicated for fetal lesions with the potential to cause life-threatening airway obstruction immediately after delivery. By maintaining utero-placental circulation, the fetal airway can be evaluated and secured prior to delivery. The anesthetic goals for the EXIT procedure differ significantly from a cesarean delivery and include profound uterine relaxation, fetal anesthesia and maintenance of the maternal-fetal circulation. We present a case of an uneventful EXIT procedure and include a discussion of the anesthetic goals for this operation.
Chang
Leon C
LC
Departments of Anesthesiology and Reproductive Medicine, UCSD Medical Center, University of California-San Diego, 200 W. Arbor Drive, San Diego, CA 92103, USA.
Kuczkowski
Krzysztof M
KM
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000402:Airway Obstruction / Q000601:surgery*; D000768:Anesthesia, General / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005333:Fetus / Q000601:surgery*; D006801:Humans; D007442:Intubation, Intratracheal; D008738:Methyl Ethers / Q000008:administration & dosage; D008844:Micrognathism / Q000150:complications; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage; D009609:Nitrous Oxide / Q000008:administration & dosage; D010102:Oxygen Inhalation Therapy; D006831:Polyhydramnios; D011247:Pregnancy; D015742:Propofol / Q000008:administration & dosage; D000077149:Sevoflurane; D013390:Succinylcholine / Q000008:administration & dosage; D014673:Vecuronium Bromide / Q000008:administration & dosage
D000759:Adjuvants, Anesthesia; D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D003473:Neuromuscular Nondepolarizing Agents; D000077149:Sevoflurane; D014673:Vecuronium Bromide; D013390:Succinylcholine; D009609:Nitrous Oxide; D005283:Fentanyl; D015742:Propofol