title: [A Case of EXIT (Ex-utero Intrapartum Treatment) in a Fetus with Prenatal Diagnosis of a Giant Cervical Tumor: Successful Airway Management but without Indication of Treatment for a Tumor].
abstract: The ex-utero intrapartum treatment (EXIT) is a rare procedure, and often comes as an emergency surgery. A careful preparation is crucial and a multidisciplinary team discussion during the prenatal period is necessary because it may be practically and ethically difficult to plan a surgical treatment for a fetus for EXIT. An elective caesarean section and EXIT for a fetus with a giant cervical tumor, which may cause airway obstruction and difficult intubation, were scheduled. The anesthesiologist tried oral intubation by direct laryngoscope; however, neither blade nor rigid bronchoscope insertion was impossible as a firm mass protruded in oral cavity from the left side. Tracheotomy was successfully performed and the airway was secured. As for maternal anesthesia, adequate uterine relaxation was obtained by inhalational agents and nitroglycerine. After ligation of the umbilical cord, anesthesia was maintained with propofol and fentanyl, and good uterine contraction was provided by infusion of oxytocin. The duration of EXIT was 44 minutes. The fetal tumor, containing both solid and cystic components, was 14 centimeters in diameter, and infiltrated into intracranial space. There was no indication of resection nor chemotherapy for the tumor. Palliative care was selected, and the neonate died forty days after birth.
authors.forename: Chikako
authors.initials: C
authors.lastname: Masamoto
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Onishi
authors.forename: Yumi
authors.initials: Y
authors.lastname: Doi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Uekita
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kagawa
mesh_terms: D000328:Adult; D058109:Airway Management / Q000379:methods; D000402:Airway Obstruction / Q000209:etiology; D002585:Cesarean Section / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D005333:Fetus; D006801:Humans; D007231:Infant, Newborn; D007828:Laryngoscopy / Q000009:adverse effects; D036801:Parturition; D011247:Pregnancy; D011296:Prenatal Diagnosis; D002583:Uterine Cervical Neoplasms / Q000150:complications; D014590:Uterine Contraction