Maternal anesthesia for EXIT procedure: A systematic review of literature

Kumar, Kamal; Miron, C; Singh, Sudha

doi:10.4103/joacp.joacp_302_17

Cited by 28 publications

(11 citation statements)

References 41 publications

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“…Although NTG is commonly used for acute tocolysis during obstetric emergencies, it is less commonly used for longer periods of tocolysis. Previous reports of NTG as the primary tocolytic agent during EXIT procedures reported a maximum duration of 21 min for intraoperative uterine relaxation [17]. In our 2 patients, we maintained adequate intraoperative tocolysis for 75 and 133 min, at least three times the upper limit previously reported.…”

Section: Discussionsupporting

confidence: 58%

“…In our 2 patients, we maintained adequate intraoperative tocolysis for 75 and 133 min, at least three times the upper limit previously reported. The most common dosing regimens for NTG in this review included a loading dose of 25–100 μg, followed by infusions ranging from 1 to 20 μg/kg/min [17]. In comparison, our maximum infusion rate was 2 μg/kg/min.…”

Section: Discussionmentioning

confidence: 99%

“…As NTG is not known to cause neurotoxicity, this protocol could minimize fetal exposure to neurotoxic medications. There have been multiple case reports of NTG being used as the sole tocolytic agent in ex-utero intrapartum treatment (EXIT) procedures [17]. However, the duration of uterine relaxation required for open MMC repair is much longer than what is needed for EXIT procedures.…”

Section: Introductionmentioning

confidence: 99%

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Avoiding the Use of Halogenated Anesthetic Agents for Uterine Relaxation in Open Mid-Gestation Fetal Surgery: A Case Report

et al. 2022

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Introduction: Profound uterine relaxation is required for open fetal surgery. This is typically achieved by the administration of high-dose halogenated anesthetic agents. However, this anesthetic technique is associated with adverse cardiovascular effects in the fetus and may have long-term neurocognitive effects as well. Case Presentation: We present reports for two patients in whom uterine relaxation was maintained with nitroglycerin and magnesium infusions without any exposures to halogenated anesthetic agents. There were no adverse fetal or maternal effects from this technique. Discussion/Conclusion: To the best of our knowledge, these are the first reports of open fetal surgery being performed without the use of halogenated anesthetic agents. This has potential short- and long-term benefits for the fetus, particularly as more complex and longer duration minimally invasive procedures are developed.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Avoiding the Use of Halogenated Anesthetic Agents for Uterine Relaxation in Open Mid-Gestation Fetal Surgery: A Case Report

et al. 2022

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“…23,24 With progress in anesthesia support and intraoperative monitoring, more surgical interventions are now available for pediatric patients and even the intrauterine fetus. These are done under various regimens of anesthesia or sedation, [25][26][27][28] leading to more frequent and possibly prolonged exposure of the developing brain to GAs. Moreover, some pediatric patients with life-threatening conditions are subject to complex surgical treatments and prolonged anesthetic exposure during the first 3 years of life.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Application of Nonhuman Primate Models in the Studies of Pediatric Anesthesia Neurotoxicity

Wang

Liu

et al. 2022

Anesthesia &Amp; Analgesia

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Numerous animal models have been used to study developmental neurotoxicity associated with short-term or prolonged exposure of common general anesthetics at clinically relevant concentrations. Pediatric anesthesia models using the nonhuman primate (NHP) may more accurately reflect the human condition because of their phylogenetic similarity to humans with regard to reproduction, development, neuroanatomy, and cognition. Although they are not as widely used as other animal models, the contribution of NHP models in the study of anesthetic-induced developmental neurotoxicity has been essential. In this review, we discuss how neonatal NHP animals have been used for modeling pediatric anesthetic exposure; how NHPs have addressed key data gaps and application of the NHP model for the studies of general anesthetic-induced developmental neurotoxicity. The appropriate application and evaluation of the NHP model in the study of general anesthetic-induced developmental neurotoxicity have played a key role in enhancing the understanding and awareness of the potential neurotoxicity associated with pediatric general anesthetics.

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“…The recent systematic review by Kumar et al reported that most of the EXIT procedures have been performed under general anesthesia. 12 To our knowledge, there have been only 10 cases that have used the regional anesthesia technique combined with NTG infusion, or combined spinalepidural anesthesia for maternal anesthesia for the EXIT procedure. This study's results showed that there were no maternal or fetal complications correlated to the single-shot spinal anesthetic technique.…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Ex-Utero Intrapartum Treatment Procedure for Cystic Teratoma Under Sole Spinal Anesthesia: an Anesthetic Challenge Case Report

Pattaravit

Karnjanawanichkul

Benjhawaleemas

2022

J Health Sci Med Res

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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.

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Maternal anesthesia for EXIT procedure: A systematic review of literature

Cited by 28 publications

References 41 publications

Avoiding the Use of Halogenated Anesthetic Agents for Uterine Relaxation in Open Mid-Gestation Fetal Surgery: A Case Report

Avoiding the Use of Halogenated Anesthetic Agents for Uterine Relaxation in Open Mid-Gestation Fetal Surgery: A Case Report

Application of Nonhuman Primate Models in the Studies of Pediatric Anesthesia Neurotoxicity

Successful Management of Ex-Utero Intrapartum Treatment Procedure for Cystic Teratoma Under Sole Spinal Anesthesia: an Anesthetic Challenge Case Report

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