Anesthetic Management during an Ex Utero Intrapartum Treatment (EXIT) Procedure of the Agnathic Fetus : A case report.
10.4097/kjae.2005.49.5.724
- Author:
Jong Taek PARK
1
;
Hye Sook CHANG
;
So Yeun KWON
;
Dae Ja UM
;
Sung Jin CHOI
Author Information
1. Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. umdj@wonju.yonsei.ac.kr
- Publication Type:Case Report
- Keywords:
agnathia;
airway management;
anesthetic management;
EXIT procedure
- MeSH:
Airway Management;
Anesthesia;
Anesthesia, Inhalation;
Atracurium;
Cesarean Section;
Female;
Fentanyl;
Fetus*;
Humans;
Inhalation;
Intubation;
Isoflurane;
Mandible;
Mothers;
Oxygen;
Oxytocin;
Postoperative Period;
Pregnancy;
Relaxation;
Uterine Inertia;
Uterus
- From:Korean Journal of Anesthesiology
2005;49(5):724-729
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
We report our experience of the anesthetic management of an ex utero intrapartum treatment (EXIT) procedure that was performed on a fetus with a mandible anomaly (agnathia) for airway management. The EXIT procedure is a method for maintaining the feto-placental circulation during a cesarean section using deep inhalation anesthesia. In the EXIT procedure, the anesthetic goal is the profound relaxation of the uterus to maintain the feto-placental circulation. High dose inhalation agents are used maintain the level of uterine relaxation. Anesthesia was induced with rapid sequence intubation and maintained with 2 vol% isoflurane and nitrous in oxygen (50:50) combined with intermittent boluses of fentanyl and atracurium. The fetus was not given any drugs other than those as a result of placental transfer and was monitored with pulse oximeter. The mother and fetus were maintained hemodynamically stable with a preserved feto-placental circulation. After delivery, the uterine tone improved soon after discontinuing the isoflurane, and the pitocin infusion was begun. There were no signs of uterine atony in the postoperative period.
