title: An ex utero intrapartum treatment procedure in a patient with a family history of malignant hyperthermia.
abstract: In the EXIT (ex utero intrapartum treatment) procedure, after uterine incision, uterine relaxation is maintained to prevent placental separation and the fetus is supported via the placenta until the airway is successfully established. The traditional method to maintain uterine relaxation is with the use of high-dose potent inhaled anesthetics during general anesthesia. A patient with a family history of malignant hyperthermia required an EXIT procedure. The history of malignant hyperthermia precluded the use of potent inhaled anesthetics and an alternate plan using propofol and remifentanil infusions for anesthesia and nitroglycerin 16 μg/kg/min for uterine relaxation allowed for good surgical conditions. The presence of malignant hyperthermia required an alternate plan and close collaboration in order to ensure good patient outcome.
authors.affiliation: Department of Anesthesiology, Mount Sinai School of Medicine, New York, NY, USA. Ira.hofer@mountsinai.org
authors.forename: I S
authors.initials: IS
authors.lastname: Hofer
authors.forename: B
authors.initials: B
authors.lastname: Mahoney
authors.forename: A
authors.initials: A
authors.lastname: Rebarber
authors.forename: Y
authors.initials: Y
authors.lastname: Beilin
mesh_terms: D000771:Anesthesia, Intravenous; D000773:Anesthesia, Obstetrical; D002585:Cesarean Section / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005333:Fetus / Q000601:surgery; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D006340:Heart Rate, Fetal; D006801:Humans; D007231:Infant, Newborn; D007828:Laryngoscopy; D008305:Malignant Hyperthermia / Q000235:genetics* / Q000628:therapy*; D009126:Muscle Relaxation / Q000187:drug effects; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D011296:Prenatal Diagnosis; D014463:Ultrasonography; D014599:Uterus / Q000187:drug effects; D055815:Young Adult
chemical_list: D010120:Oxytocics; D010121:Oxytocin