Korean J Anesthesiol.  2005 Nov;49(5):724-729. 10.4097/kjae.2005.49.5.724.

Anesthetic Management during an Ex Utero Intrapartum Treatment (EXIT) Procedure of the Agnathic Fetus : A case report

• Park JT
• Chang HS
• Kwon SY
• Um DJ
• Choi SJ

• KMID: 1936837
• DOI: http://doi.org/10.4097/kjae.2005.49.5.724

Abstract

We report our experience of the anesthetic management of an ex utero intrapartum treatment (EXIT) procedure that was performed on a fetus with a mandible anomaly (agnathia) for airway management. The EXIT procedure is a method for maintaining the feto-placental circulation during a cesarean section using deep inhalation anesthesia. In the EXIT procedure, the anesthetic goal is the profound relaxation of the uterus to maintain the feto-placental circulation. High dose inhalation agents are used maintain the level of uterine relaxation. Anesthesia was induced with rapid sequence intubation and maintained with 2 vol% isoflurane and nitrous in oxygen (50:50) combined with intermittent boluses of fentanyl and atracurium. The fetus was not given any drugs other than those as a result of placental transfer and was monitored with pulse oximeter. The mother and fetus were maintained hemodynamically stable with a preserved feto-placental circulation. After delivery, the uterine tone improved soon after discontinuing the isoflurane, and the pitocin infusion was begun. There were no signs of uterine atony in the postoperative period.

Keyword

agnathia; airway management; anesthetic management; EXIT procedure

MeSH Terms

Airway Management
Anesthesia
Anesthesia, Inhalation
Atracurium
Cesarean Section
Female
Fentanyl
Fetus*
Humans
Inhalation
Intubation
Isoflurane
Mandible
Mothers
Oxygen
Oxytocin
Postoperative Period
Pregnancy
Relaxation
Uterine Inertia
Uterus
Atracurium
Fentanyl
Isoflurane
Oxygen
Oxytocin