Anesthesia for ex utero intrapartum treatment (EXIT procedure) in fetus with prenatal diagnosis of oral and cervical malformations: case reports.
OBJECTIVE
Fetus prenatally diagnosed with neck tumors, or with any other disease that obstructs the airways, should not be treated conventionally, as the assistant physician has to face two challenges right after the infant's delivery: the limited time to establish the access to the potentially difficult airways and the lack of anesthesia of the neonate in case of instrumentation of the airways. The ex utero intrapartum treatment, i.e., the EXIT procedure consists of maintaining the fetoplacental circulation during the cesarean section, until the airways of the fetus be secured.


METHODS
Female patient, 37 years old, G3P2, 38 weeks pregnant, having polyhydramnios and fetus diagnosed with large cervical masses by prenatal ultrasound. A cesarean section was performed using the EXIT procedure to enable safe access to the infant's airways. After hysterotomy, the fetus was intubated by direct laryngoscopy. The neonate was immediately transferred to another operating room, where cervical tumor resection of the neck tumor and tracheostomy were successfully performed. Female patient, 27 years old, G3P1A1, 32 weeks pregnant, whose fetus was prenatally diagnosed with a large oral tumor. As the tumor obstructed the fetus' airways, a tracheostomy was performed when the fetus underwent EXIT procedure. It was then possible to use direct laryngoscopy for neonate intubation. The fetus underwent tumor resection and was sent to the Neonatal Intensive Care Unit.


CONCLUSIONS
Reports describe the successful use of general anesthesia with isoflurane for cesarean delivery followed by the EXIT procedure in fetus diagnosed with tumors obstructing the airways.
Department of Anesthesiology, Pain and Intensive Care, Universidade Federal de São Paulo-Escola Paulista de Medicina (UNIFESP-EPM), Vila Clementino, São Paulo, SP, Brazil. helferdc@yahoo.com.br
Daniel Corrêa
DC
Helfer
Jefferson
J
Clivatti
Américo Massafuni
AM
Yamashita
Antonio Fernades
AF
Moron
D000328:Adult; D000758:Anesthesia / Q000379:methods*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000601:surgery*; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000601:surgery*; D007231:Infant, Newborn; D007743:Labor, Obstetric; D018191:Lymphangioma, Cystic / Q000175:diagnosis / Q000601:surgery*; D009062:Mouth Neoplasms / Q000175:diagnosis / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D013724:Teratoma / Q000175:diagnosis / Q000601:surgery*