Case series: Combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure

Department of Anesthesiology, Women's Anesthesia and Critical Care, Box 3094, Duke University Medical Center, Durham, NC 27710, USA.
Canadian Journal of Anaesthesia (Impact Factor: 2.53). 04/2007; 54(3):218-22. DOI: 10.1007/BF03022643
Source: PubMed

ABSTRACT To report the use of regional anesthesia and iv nitroglycerin to provide anesthesia and uterine relaxation for three Cesarean deliveries (CD) involving ex utero intrapartum treatment (EXIT) of potentially life-threatening airway obstruction in the newborn.
Case 1--a 36-yr-old woman at 38 weeks' gestation was scheduled for an elective CD for fetal skeletal dysplasia and micrognathia. Case 2--a 34-yr-old woman at 35 weeks gestation had a fetal ultrasound revealing fixed neck flexion and micrognathia consistent with fetal arthrogryposis. Case 3--a 27-yr-old woman presented at 38 weeks gestation for CD for severe fetal micrognathia, with mandibular growth below the fifth percentile. For each case, a combined spinal epidural anesthetic was performed with 0.75% bupivacaine, fentanyl and morphine intrathecally followed by placement of a multiorifice epidural catheter. Prior to uterine incision patients received a loading dose followed by an iv infusion of nitroglycerin. Uterine relaxation was sufficient in all cases for delivery of the fetus, and allowed for evaluation by direct laryngoscopy and intubation while maintaining fetal-placental circulation. The surgical procedures were completed without incident.
Anesthesia and uterine relaxation for CD and EXIT procedures can be safely provided with regional anesthesia and iv nitroglycerin.

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Available from: Ashraf Habib, Dec 25, 2013
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    • "The ex utero intrapartum treatment (EXIT) procedure is an uncommon technique that is implemented to increase the rate of fetal survival at delivery of fetuses with congenital life-threatening airway obstructions such as lingual cysts [1], teratomas [2,3], skeletal dysplasia and micrognathia [4], and cystic hygromas, thyroid goiters, and neuroblastomas [5]. "
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    ABSTRACT: The ex utero intrapartum treatment (EXIT) procedure is a very rare technique performed in cases of fetal congenital malformations. The EXIT procedure increases the rate of survival at delivery by maintaining the uteroplacental circulation until the airway of the fetus is secured. To maintain the uteroplacental circulation, a higher dose of inhalational anesthetics and/or intravenous nitroglycerin can be used as compared to conventional Cesarean section. The aim of this report is to share our anesthetic experience during the EXIT procedure with members of the Korean society of anesthesiology for the first time, and to highlight the maternal implications of the use of inhalational anesthetics and nitroglycerin during Cesarean section for the EXIT procedure.
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    Canadian Journal of Anaesthesia 04/2007; 54(3):171-5. DOI:10.1007/BF03022636 · 2.53 Impact Factor
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