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Anesthesiology pp 473-483 | Cite as

Anesthesia for Ex-Utero Intra-Partum Procedures

  • Magdy Takla
  • Irwin Gratz
  • Bharathi Gourkanti
Chapter

Abstract

Ex Utero Intrapartum Treatment (EXIT) are therapeutic interventions that are part of an extended cesarean section for fetuses with a variety of life-threatening airway abnormalities or congenital malformations. The anesthetic goals are to maintain the integrity of the maternal-fetal circulation while maintaining optimal uterine relaxation, the physiology and anesthetic goal of the EXIT procedure are reviewed and modifications to the classic treatment discussed. Multidisciplinary collaboration is required for optimum results.

Keywords

Ex utero intrapartum treatment (EXIT) Fetal malformation Cesarean delivery General anesthesia Fetal anesthesia Obstetric anesthesia 

References

  1. 1.
    Marquesa MV, Carneiroa J, Adrianob M, Lanca F. Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure. Braz J Anesthesiol. 2015;65(6):525–8.CrossRefGoogle Scholar
  2. 2.
    Filipchuk D, Avdimiretz L. The ex utero intrapartum treatment (EXIT) procedure for fetal head and neck masses. AORN. 2009;90(5):661–72.CrossRefGoogle Scholar
  3. 3.
    García-Díaz L, de Agustín JC, Ontanilla A, et al. EXIT procedure in twin pregnancy: a series of three cases from a single center. BMC Pregnancy Childbirth. 2014;14:252.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Nnamani N. From ‘OOPS to EXIT’: a review of the origins and progression of ex utero intrapartum treatment. J Anesth Clin Res. 2015;6(7):540.CrossRefGoogle Scholar
  5. 5.
    Chiu HH, Hsu WC, Shih JC, Tsao PN, Hsieh WS, Chou HC. The EXIT (ex utero intrapartum treatment) procedure. J Formos Med Assoc. 2008;107(9):745–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Dighe MK, Peterson SE, Dubinsky TJ, Perkins J, Cheng E. EXIT procedure: technique and indications with prenatal imaging parameters for assessment of airway patency. Radiographics. 2011;31(2):511–26.CrossRefPubMedGoogle Scholar
  7. 7.
    Chinnappa V, Halpern SH. The ex utero intrapartum treatment (EXIT) procedure: maternal and fetal considerations. Can J Anaesth. 2007;54(3):171–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Kinsella SM, Winton AL, Mushambi MC, et al. Failed tracheal intubation during obstetric general anaesthesia: a literature review. Int J Obstet Anesth. 2015;24(4):356–74.CrossRefPubMedGoogle Scholar
  9. 9.
    Derderian SC, Hirose S. Fetal surgery for congenital high airway obstruction. Medscape. 2013 Aug 15.Google Scholar
  10. 10.
    Courtier J, Poder L, Wang Z, Westphalen AC, Yeh BM, Coakley FV. Fetal tracheolaryngeal airway obstruction: prenatal evaluation by sonography and MRI. Pediatr Radiol. 2010;40(11):1800–5.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Jelin EB, Jelin AC. Fetal surgery for congenital pulmonary airway malformation. Medscape.2013 Jan 30.Google Scholar
  12. 12.
    Goldsmith JP, Karotkin E. Assisted ventilation of the neonate. 5th ed. New York: Elsevier; 2010. 656 p.Google Scholar
  13. 13.
    Tonni G, Granese R, Martins Santana EF, et al. Prenatally diagnosed fetal tumors of the head and neck: a systematic review with antenatal and postnatal outcomes over the past 20 years. J Perinat Med. 2017;45(2):149–65.  https://doi.org/10.1515/jpm-2016-0074.CrossRefPubMedGoogle Scholar
  14. 14.
    Garcia PJ, Olutoye OO, Ivey RT, Olutoye OA. Case scenario: anesthesia for maternal-fetal surgery: the ex utero Intrapartum therapy (EXIT) procedure. Anesthesiology. 2011;114(6):1446–52.CrossRefPubMedGoogle Scholar
  15. 15.
    Gaiser RR, Cheek TG, Kurth CD. Anesthetic management of cesarean delivery complicated by ex utero intrapartum treatment of the fetus. Anesth Analg. 1997;84(5):1150–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Restrepo CE, Gomez ME, Puerta JJ, Upegui A. Anaesthesia for the EXIT procedure: the value of fast track anesthesia. Int J Obstet Anesth. 2006;15:S43.Google Scholar
  17. 17.
    Boat A, Mahmoud M, Michelfelder EC, et al. Supplementing desflurane with intravenous anesthesia reduces fetal cardiac dysfunction during open fetal surgery. Paediatr Anaesth. 2010;20(8):748–56.  https://doi.org/10.1111/j.1460-9592.2010.CrossRefPubMedGoogle Scholar
  18. 18.
    George RB, Melnick AH, Rose EC, Habib AS. Case series: combined spinal epidural anesthesia for cesarean delivery and ex utero intrapartum treatment procedure. Can J Anaesth. 2007;54(3):218–22.CrossRefPubMedGoogle Scholar
  19. 19.
    Haydon ML, Gorenberg DM, Nageotte MP, et al. The effect of maternal oxygen administration on fetal pulse oximetry during labor in fetuses with nonreassuring fetal heart rate patterns. Am J Obstet Gynecol. 2006;195(3):735–8.CrossRefPubMedGoogle Scholar
  20. 20.
    Hirose S, Harrison MR. The ex utero intrapartum treatment (EXIT) procedure. Semin Neonatol. 2003;8(3):207–14. Review.CrossRefPubMedGoogle Scholar
  21. 21.
    Baker PA, Aftimos S, Anderson BJ. Airway management during an EXIT procedure for a fetus dysgnathia complex. Paediatr Anaesth. 2004;14(9):781–6.CrossRefPubMedGoogle Scholar
  22. 22.
    Schwartz DA, Moriarty KP, Tashjian DB, et al. Anesthetic management of the exit (ex utero intrapartum treatment procedure). J Clin Anesth. 2001;13(5):387–91.CrossRefPubMedGoogle Scholar
  23. 23.
    Marwan A, Crombleholme TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg. 2006;15:107–15.CrossRefPubMedGoogle Scholar
  24. 24.
    Bouchard S, Johnson MP, Flake AW, et al. The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg. 2002;37(3):418–26.CrossRefPubMedGoogle Scholar
  25. 25.
    Hirose S, Farmer DL, Lee H, Nobuhara KK, Harrison MR. The ex utero intrapartum treatment procedure: looking back at the EXIT. J Pediatr Surg. 2004;39(3):375–80; discussion 375–80.CrossRefPubMedGoogle Scholar
  26. 26.
    Noah MM, Norton ME, Sandberg P, Esakoff T, Farrell J, Albanese CT. Short term maternal outcomes that are associated with the EXIT procedure as compared with caesarean delivery. Am J Obstet Gynecol. 2002;186(4):773–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cooper Medical School Rowan University, Cooper University HospitalCamdenUSA

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