New Approach to the Management of Airway Obstruction in "High Risk" Neonates

Catalano, Peter J.; Urken, Mark L.; Álvarez, Manuel; Norton, Karen I.; Wedgewood, J.; Holzman, Ian R.; Biller, Hugh F.

doi:10.1001/archotol.1992.01880030094019

Cited by 98 publications

(64 citation statements)

References 6 publications

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“…This allows time for the surgical team to stabilize the fetal airway before interruption of maternal circulation and delivering the neonate to the neonatology team. First described in 1992 for a fetal epignathus [1], and later refined for the reversal of tracheal clippings in the treatment of patients with congenital diaphragmatic hernias [2,3], the indications for EXIT procedures are expanding for stabilizing fetal cardio-pulmonary statuses.…”

Section: Discussionmentioning

confidence: 99%

“…It involves obstetrics partially delivering the infant while maintaining uteroplacental circulation, so that the pediatric otolaryngologist can evaluate and secure a threatened airway. First described in 1992 for a fetus with obstructing epignathus [1], the EXIT procedure was refined during its use for the reversal of tracheal occlusion in patients with congenital diaphragmatic hernias [2,3].…”

Section: Introductionmentioning

confidence: 99%

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The use of remifentanil in ex utero intrapartum treatment procedures

Whited¹,

Raynor²

2013

OJPed

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Purpose: We propose that using remifentanil in ex utero intrapartum treatment (EXIT) procedures reduces the need for maternal exposure to general anesthesia. Using remifentanil along with spinal anesthesia eliminates the fetal and maternal risks associated with inhalational general anesthesia, allows the mother to be awake, and obviates the need for and costs associated with general anesthesia and a second anesthesia team. Materials and Methods: We performed a retrospective review of all sequential patients undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia, using nitroglycerine as a tocolytic agent and remifentanil for analgesia. Variables included indication, time to secured fetal airway, complications, estimated blood loss, need for additional anesthetics, participating personnel, and survival. Results: All five of our ex utero intrapartum treatment procedures were successfully completed with combined spinal epidural remifentanil anesthetic. No patient was required additional alternative anesthetic. There were no complications with mother or fetus. Indications for procedure were arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All five mothers were conscious during their procedure. Conclusions: We report the largest series of ex utero intrapartum treatment procedures performed with remifentanil regional anesthesia. We found that the combined use of nitroglycerin and regional remifentanil anesthesia is a safe alternative to the pediatric otolaryngologist for performing ex utero intrapartum treatment procedures without the risks of general anesthesia, allowing the mother to be awake for the delivery, and reducing the cost of providing care.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of remifentanil in ex utero intrapartum treatment procedures

Whited¹,

Raynor²

2013

OJPed

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“…Even its unique appearance, clinical correct diagnosis may be difficult until biopsy or surgical resection is done to prove its histological three germ layers' components (1,4,11) . Differential diagnosis includes ethmo-basal encephalocele, cystic hygroma, dermoid cyst, lymphangioma, rhabdomyosarcoma (3,7) . CT scan or MRI is valuable to distinguish a teratoma from other tumors (3,…”

Section: Discussionmentioning

confidence: 99%

“…In terms of recent advance in ultrasound resolution, prenatal diagnosis of giant mass from the mouth may be diagnosed so that a multidisciplinary team by neonatologist, gynecologist, anesthesiologist, pediatric surgeon, oral surgeon must work during the labour and after birth to improve the baby's chance to survive (3,9) . And for associate anomalies such as macrostomia, cleft palate, and other craniofacial distortions, cooperative team management is also essential to obtain better quality of life (1,9) .…”

Section: 7)mentioning

confidence: 99%

Neonatal Epignathus with Cleft Palate: A Case Report

Kyutoku¹,

Yasui²,

Shima³

et al. 2001

The Journal of Kansai Medical University

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“…1,4,5 Langer et al reported a fetus with a large cervical teratoma diagnosed prenatally by ultrasound examination which was delivered through the hysterotomy to the shoulders and the trachea was intubated. Despite the initial success in the management of the upper airway obstruction, the neonate subsequently died of massive airway bleeding from the tumour.…”

Section: Discussionmentioning

confidence: 99%