INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a car...INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.展开更多
The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestrat...The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestration, cervical teratomas, or other congenital conditions. EXIT is erroneously known as a routine cesarean section (CS), but is rather an extension of CS with discernible differences. The procedure creates an opening in the anesthetized abdomen of the mother and uterus. Once EXIT is complete, the remainder of the CS proceeds. EXIT is much more complex than a routine CS, as it requires coordination between the mother and a multidisciplinary team of surgical and neonatal personnel. This review highlights current anesthetic concepts during the EXIT procedure.展开更多
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 ...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.展开更多
“The fetus as a patient”是国际胎儿学会宣言的标题，强调对胎儿生命权的尊重，对患有疾病的胎儿进行积极的救治这一理念已经深入人心。产时胎儿宫外治疗的开展即是基于这一理念。随着产前诊断技术的发展，很多胎儿先天性畸形得到早...“The fetus as a patient”是国际胎儿学会宣言的标题，强调对胎儿生命权的尊重，对患有疾病的胎儿进行积极的救治这一理念已经深入人心。产时胎儿宫外治疗的开展即是基于这一理念。随着产前诊断技术的发展，很多胎儿先天性畸形得到早期的宫内诊断，为这一技术的开展提供了基础。展开更多
文摘INTRODUCTION The incidence of fetal cardiac tumor was about 0.14% as determined by fetal echocardiography. It was extremely difficult to deal with the fetus when the severe circulatory instability was induced by a cardiac tumor in the womb. It was reported that ex utero intrapartum treatment （EXIT） procedure solved the problems of fetal airway or pulmonary lesion during delivery to avoid hypoxia after birth. The goal of EXIT is to maintain placental circulation while steps are taken to optimize the transition of the baby from fetal to neonatal life. This study introduced the experience of EXIT procedure to solve the problems of fetal circulation induced by a fetal cardiac tumor.
文摘The anesthesia ex utero intrapartum treatment (EXIT) procedure is a specialized surgical procedure used to deliver babies who have airway compression due to cystic adenomatoid malformation, bronchopulmonary sequestration, cervical teratomas, or other congenital conditions. EXIT is erroneously known as a routine cesarean section (CS), but is rather an extension of CS with discernible differences. The procedure creates an opening in the anesthetized abdomen of the mother and uterus. Once EXIT is complete, the remainder of the CS proceeds. EXIT is much more complex than a routine CS, as it requires coordination between the mother and a multidisciplinary team of surgical and neonatal personnel. This review highlights current anesthetic concepts during the EXIT procedure.
文摘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.
