Anesthetic consideration for ex-utero intrapartum treatment procedure: A case series

Abstract

Ex-utero intrapartum treatment (EXIT) is a rare surgical procedure performed intrapartum in cases of anticipated fetal abnormalities. The most important anesthetic consideration for the EXIT procedure is maintaining fetomaternal circulation during the operation through uterine relaxation with anesthetic gases in general anesthesia or nitroglycerin in regional anesthesia. Two patients were initially scheduled for elective C-sections under neuraxial anesthesia, but due to a premature rupture of the membrane and deceleration of the fetal heart rate, one was carried out as planned, and the other was converted to general anesthesia. In the second case, anesthetic gases were used to achieve uterine relaxation, whereas in the first case, oxytocin was delayed. Mothers were transferred to the low-care ward, whereas infants were transferred to the neonatal intensive care unit and underwent definitive surgery within 1–2 weeks after birth. The EXIT procedure could be used under general and regional anesthesia in elective and emergency settings.

Keywords

• ex-utero intrapartum treatment procedure
• exit procedure
• general anesthesia
• neuraxial anesthesia
• regional anesthesia