Successful Management of Ex-Utero Intrapartum Treatment Procedure for Cystic Teratoma Under Sole Spinal Anesthesia: an Anesthetic Challenge Case Report
DOI:
https://doi.org/10.31584/jhsmr.2022899Keywords:
case report, congenital teratoma, EXIT procedure, neuraxial anesthesiaAbstract
The Ex-Utero Intrapartum Treatment (EXIT) procedure is a technique that establishes the fetus’s airway, while uteroplacental fetal circulation is still maintained. Anesthesia for this specific procedure requires special anesthetic considerations; such as, uterine relaxation, maternal hemodynamic parameters, the establishment of a fetal airway and maintenance of postpartum uterine contraction. In most cases, general anesthesia is used as the preferred method, due to its effect on uterine relaxation. This presented case demonstrated that a sole spinal anesthetic technique can be used safely for an EXIT procedure.
References
Liechty KW. Ex-utero intrapartum therapy. Semin Fetal Neonatal Med 2010;15:34-9.
Mychaliska GB, Bealer JF, Graf JL, Rosen MA, Adzick NS, Harrison MR. Operating on placental support: the ex utero intra partum treatment procedure. J Pediatr Surg 1997;32:227-30.
Garcia PJ, Olutoye OO, Ivey RT, Olutoye OA. Case scenario: anesthesia for maternal-fetal surgery: the Ex Utero Intrapartum Therapy (EXIT) procedure. Anesthesiology 2011;114:1446-52.
Lee H, Ryu JW, Kim DY, Lee GY. Anesthetic management of the ex utero intrapartum treatment (EXIT) procedure - A case report. Korean J Anesthesiol 2010;59(Suppl):S154-7. doi: 10.4097/kjae.2010.59.S.S154.
De Backer A, Madern GC, van de Ven CP, Tibboel D, Hazebroek FW. Strategy for management of newborns with cervical teratoma. J Perinat Med 2004;32:500-8.
Griffiths SK, Campbell JP. Placental structure, function and drug transfer. Contin Educ Anaesth Crit Care Pain 2015;15:84-9. doi: 10.1093/bjaceaccp/mku013.
George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth 2007;54:218-22.
Benonis JG, Habib AS. Ex utero intrapartum treatment procedure in a patient with arthrogryposis multiplex congenita, using continuous spinal anesthesia and intravenous nitroglycerin for uterine relaxation. Int J Obstet Anesth 2008;17:53-6.
Fink RJ, Allen TK, Habib AS. Remifentanil for fetal immobilization and analgesia during the ex utero intrapartum treatment procedure under combined spinal-epidural anaesthesia. Br J Anaesth 2011;106:851-5.
Cyna AM, Andrew M, Emmett RS, Middleton P, Simmons SW. Techniques for preventing hypotension during spinal anaesthesia for caesarean section. Cochrane Database Syst Rev 2006;18: CD002251.
Chandraharan E, Arulkumaran S. Acute tocolysis. Curr Opin Obstet Gynecol 2005;17:151-6.
Kumar K, Miron C, Singh SI. Maternal anesthesia for EXIT procedure: a systematic review of literature. J Anaesthesiol Clin Pharmacol 2019;35:19-24. doi:10.4103/joacp.JOACP_302_17.
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