Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure

Miguel Vieira Marques; João Carneiro; Marta Adriano; Filipa Lança

doi:10.1016/j.bjane.2013.12.002

Clinical Information

Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure

Anestesia para tratamento ex-útero intraparto: visão renovada sobre um procedimento raro

Miguel Vieira Marques; João Carneiro; Marta Adriano; Filipa Lança

http://dx.doi.org/10.1016/j.bjane.2013.12.002 Braz J Anesthesiol, vol.65, n6, p.525-528, 2015

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Abstract

The ex utero intrapartum treatment is a rare surgical procedure performed in cases of expected postpartum fetal airway obstruction. The technique lies on a safe establishment of a patent airway during labor in anticipation of a critical respiratory event, without interrupting maternal-fetal circulation. Anesthetic management is substantially different from that regarding standard cesarean delivery and its main goals include uterine relaxation, fetal anesthesia and preservation of placental blood flow. We present the case of an ex utero intrapartum treatment procedure performed on a fetus with a large cervical lymphangioma and prenatal evidence of airway compromise. Modifications to the classic ex utero intrapartum treatment management strategies were successfully adopted and will be discussed in the following report.

Keywords

Airway - obstruction, Anesthesia - fetal, Anesthesia - obstetric, Cervical lymphangioma, EXIT

Resumo

O tratamento ex-útero intraparto é um procedimento cirúrgico feito em casos raros de obstrução esperada das vias aéreas fetais no pós-parto. A técnica tem como base o estabelecimento seguro de vias aéreas permeáveis durante o trabalho de parto em antecipação a um evento respiratório crítico, sem interromper a circulação materno-fetal. O manejo anestésico é substancialmente diferente daquele destinado à cesariana padrão e tem como principais objetivos o relaxamento uterino, a anestesia fetal e a preservação do fluxo sanguíneo placentário. Apresentamos o caso de um procedimento para tratamento ex-útero intraparto feito em feto com um grande linfangioma cervical e evidência pré-natal de comprometimento das vias aéreas. As modificações das estratégias adotadas no tratamento ex-útero intraparto clássico foram feitas com sucesso e serão discutidas no relato a seguir.

Palavras-chave

Vias aéreas - obstrução, Anestesia - fetal, Anestesia - obstétrica, Linfangioma cervical, EXIT

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Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure

Anestesia para tratamento ex-útero intraparto: visão renovada sobre um procedimento raro

Miguel Vieira Marques; João Carneiro; Marta Adriano; Filipa Lança

Abstract

Keywords

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