The survival rate and prognosis for neonates with airway obstruction is poor if not managed immediately after delivery. Ex utero intrapartum treatment (EXIT) is indicated for cases in which airway obstruction is anticipated. The procedure establishes the fetal airway prior to complete delivery while maintaining an intact uteroplacental circulation. Maintaining uteroplacental circulation, ensuring uterine relaxation, and temporizing placental detachment during the EXIT procedure are achieved by administering a higher dose of inhalation anesthetic and intravenous nitroglycerine. However, this can lead to maternal hypotension and compromised feto-placental perfusion, reduced fatal cardiac output and acidosis. It is therefore essential that these be managed using vasopressors and inotropes. This paper reports the first institutional experience with the EXIT procedure in the Philippines, presenting two cases of neonates with large cystic hygroma. One case was performed as an elective procedure, the other as emergency treatment.

Human ; Female ; Adult ; Acidosis ; Airway Obstruction ; Anesthetics, Inhalation ; Cardiac Output ; Emergency Treatment ; Fetus ; Hypotension ; Infant, Newborn ; Lymphangioma, Cystic ; Philippines ; Placental Circulation ; Pregnancy ; Prognosis ; Survival Rate

Phantom limb pain (PLP) is difficult to control, and patients frequently exhibit inadequate relief from medications or encounter unbearable side effects. We present here a novel application of erector spinae plane (ESP) block to manage PLP. Our patient is a 23-year-old, college student, diagnosed with high-grade osteosarcoma of the right humerus who underwent a right shoulder disarticulation. He reported PLP despite multimodal analgesia postoperatively. An ESP block using a high-frequency linear probe ultrasound was performed. A G23 spinal needle was advanced inplane toward the right T3 transverse process. After negative aspiration, 20 mL of therapeutic solution containing bupivacaine 0.25%, lidocaine 1%, epinephrine 5 mcg/ml, and 40 mg methylprednisolone was injected. After the procedure, the patient reported that his PLP went down to NRS 1/10. He consistently reported to have an NRS score of 0-1/10 on succeeding consultations despite discontinuation of opioid and pregabalin. In literature, ESP block has been used as a regional technique for shoulder disarticulation surgery and other neuropathic pain conditions, but no account has shown its use for PLP treatment. The procedure was successfully done to alleviate the upper extremity phantom limb pain, significantly reduce analgesic requirements, and improve tolerance of physical therapy and overall quality of life.
Phantom Limb ; Cancer Pain