Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.02.015
Brazilian Journal of Anesthesiology
Clinical Information

The multidisciplinary challenge of anesthesia for ex utero intrapartum treatment: a case report

O desafio multidisciplinar da anestesia para procedimento intraparto extra-uterino: relato de caso

Alexandre Caldeira, Jânia Pacheco, Sofia Fernandes, Filipa Lança

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Abstract

The Ex Utero Intrapartum Treatment (EXIT) is a surgical procedure performed in cases of expected postpartum fetal airway obstruction, allowing the establishment of patent airway while maintaining placental circulation. Anesthesia for EXIT procedure has several specific features such as adequate uterine relaxation, maintenance of maternal blood pressure fetal anesthesia and fetal airway establishment. The anesthesiologist should be aware of these particularities in order to contribute to a favorable outcome. This is a case report of an EXIT procedure performed on a fetus with a cervical lymphangioma with prenatal evidence of partial obstruction of the trachea and risk of post-delivery airway compromise

Keywords

Airway obstruction;  Anesthesia;  Cervical lymphangioma;  EXIT procedure

Resumo

O procedimento Intraparto Extra-Uterino (EXIT) é procedimento cirúrgico realizado em casos de previsão de obstrução de via aérea fetal no pós-parto, que permite estabelecer via aérea patente enquanto a circulação placentária é mantida. A anestesia para o procedimento EXIT apresenta várias características específicas, tais como relaxamento uterino adequado, manutenção da pressão arterial materna, anestesia fetal e estabelecimento da via aérea fetal. O anestesiologista deve estar ciente dessas especificidades para contribuir para desfecho favorável. Trata-se de relato de caso de procedimento EXIT realizado em feto com linfangioma cervical e evidência pré-natal de obstrução parcial de traqueia e risco de comprometimento de via aérea pós-parto.

Palavras-chave

Obstrução de vias aéreas;  Anestesia;  Linfangioma cervical;  Procedimento EXIT

References

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3. Marwan A, Crombleholme TM. The exit procedure: principles, pitfalls, and progress. Semin Pediatr Surg. 2006;15:107---15.

4. Chang LC, Kuczkowski KM. The ex utero intrapartum treatment procedure: anesthetic considerations. Arch Gynecol Obstet. 2008;277:83---5. A. Caldeira et al.

5. Helfer DC, Clivatti J, Yamashita AM, et al. Anesthesia for ex utero intrapartum treatment (EXIT procedure) in Fetus with prenatal diagnosis of oral and cervical malformations: case reports. Rev Bras Anestesiol. 2012;62:411---23.

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Rev. Bras. Anestesiol.

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