| Anesthetic Management during an Ex Utero Intrapartum Treatment (EXIT) Procedure of the Agnathic Fetus : A case report. |
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Jong Taek Park, Hye Sook Chang, So Yeun Kwon, Dae Ja Um, Sung Jin Choi |
1Department of Anesthesiology and Pain Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. umdj@wonju.yonsei.ac.kr
2Department of Obstetric Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea. |
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| Abstract |
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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. |
| Key Words:
agnathia; airway management; anesthetic management; EXIT procedure |
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