Anesthesia for Ex Utero Intrapartum Treatment (EXIT procedure) in Fetus with Prenatal Diagnosis of Oral and Cervical Malformations: Case Reports

Abstract

Reports describe the successful use of general anesthesia with isoflurane for cesarean delivery followed by the EXIT procedure in fetus diagnosed with tumors obstructing the airways.

Maternal anesthesia for EXIT procedure: A systematic review of literature

“…Since then, the indications for EXIT procedures have expanded to include a variety of fetal congenital abnormalities such as congenital high airway obstruction syndrome (CHAOS), laryngeal or tracheal atresia/stenosis, intrathoracic lesions (lung and mediastinal masses, pulmonary arteriovenous malformation with pulmonary hypoplasia), as well as congenital diaphragmatic hernias. [ 2 3 4 ]…”

“…Anesthetic management of the EXIT procedure is challenging and different from a standard cesarean section and involves providing profound uterine relaxation, maintenance of uteroplacental blood flow, and fetal anesthesia. [ 2 3 4 7 8 9 ]…”

Role of anesthesiologist in ex utero intrapartum treatment procedure: A case and review of anesthetic management

“…All inhalational agents ranging from halothane to desflurane have been successfully used for EXIT. [ 4 9 10 11 12 13 14 15 16 17 18 19 ] Desflurane was most commonly used by Lin et al . (61 of the 65 cases).…”

Fetal neck tumors – antenatal and intrapartum management

“…The whole procedure, including the maintenance of placental support www. journals.viamedica.pl/ginekologia_polska of the fetus, requires adequate uterine muscle relaxation which is only possible through deep maternal anaesthesia [19,20]. During the procedure fetal life parameters should be monitored with a pulse oximeter and an intraoperative echocardiography.…”