Operating on placental support: The ex utero intrapartum treatment procedure

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

“…While some previous reports recommended giving 100% oxygen, 1,5,9 an inspired oxygen concentration of 50% also provided adequate fetal oxygenation. 6,11 In retrospect, it would have probably been prudent to administer 100% oxygen, especially since we were unable to reliably monitor the fetal oxygen saturation during the procedure.…”

“…Uterine relaxation is necessary to prevent placental separation from the endometrium, thereby maintaining placental perfusion and fetal oxygenation allowing the delivery, either partial or full, of the fetus and appropriate airway management. 1,[4][5][6]8,11 Since the inception of fetal surgery in 1981, relatively high concentrations of volatile anesthetics (1.5-3 minimal alveolar concentration) have been used routinely to provide surgical tocolysis. 8,12 The literature is replete with case reports of general anesthesia for EXIT procedures.…”

“…The EXIT procedure involves partial delivery of the fetus and maintenance of fetal-placental circulation allowing for management of the obstructed fetal airway with direct laryngoscopy, bronchoscopy, or tracheostomy. While this procedure originally gained popularity for establishing a patent airway and removal of tracheal occluding plugs used for the treatment of congenital diaphragmatic hernia, 1 indications have now grown to include a variety of congenital airway obstructions. [2][3][4][5][6][7] A deep general anesthetic with halogenated agents has been the anesthetic technique of choice for EXIT procedures.…”

Anesthetic management of the exit (Ex Utero intrapartum treatment) procedure

“…Previous reports on the EXIT procedure advocate 100% oxygen either during the entire procedure [5][6][7] or during hysterotomy. 4 Because it is our usual practice to provide a 50% O 2 -N 2 O mixture during cesarean births, and because we were monitoring fetal SpO 2 with a pulse oximeter during the fetal surgery, we felt that fetal O 2 delivery would be adequate with a maternal inspired O 2 concentration (FIO 2 ) of 50%.…”

Nuevos desafíos en cirugía fetal

“…El procedimiento de EXIT fue inicialmente descrito para revertir la oclusión traqueal al momento del nacimiento en fetos con hernia diafragmática severa que fueron tratados con oclusión traqueal con clips en útero para promover el crecimiento pulmonar 22 . Actualmente este procedimiento ha expandido su indicación a: 1) fetos con obstrucción de la vía aérea superior en que se anticipa un dificultad para obtener una vía aérea fácilmente (figura 3); 2) Fetos con masas mediastinicas o toráci-cas grandes que requieren de su resección para asegurar la ventilación; 3) situaciones en las cuales es necesario una intervención inmediata, ya que existe un riesgo elevado en transportar al neonato a un pabellón quirúrgico (tabla 3).…”