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Congenital Cervical Teratoma:Anaesthetic Management (The EXIT Procedure).
MedLine Citation:
PMID:  20640096     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
SUMMARY: Ex utero intrapartum treatment (EXIT) is a procedure performed during caesarean section with preservation of fetal-placental circulation, which allows the safe handling of fetal airways with risk of airways obstruction. This report aimed at describing a case of anaesthesia for EXIT in a fetus with cervical teratoma. A 30-year-old woman, 70 kg, 160 cm, gravida 2, para 1, was followed because of polyhydramniosis diagnosed at 24 weeks' gestation. During a routine ultrasonographic examination at 35 weeks' gestation, it was noticed that the fetus had a tumoral mass on the anterior neck, the mass had cystic and calcified components and with a size of was 10 x 6 x5 cm. The patient with physical status ASA I, was submitted to caesarean section under general anaesthesia with mechanically controlled ventilation for exutero intrapartum treatment (EXIT). Anaesthesia was induced in rapid sequence with fentanyl propofol and rocuronium and was maintained with isoflurane in 2.5 at 3 % in O and N O (50%). After hysterotomy, fetus was partially released assuring uterus-placental circulation, followed by fetal laryngoscopy and tracheal intubation. The infant was intubated with an uncuffed, size 2.5 endotracheal tube. Excision of the mass was performed under general anaesthesia. After surgical intervention, on the fourth postoperative day, the infant was extubated and the newborn was discharged to the pediatric neonatal unit and on the seventh day postoperatively to home without complications. Major recommendations for EXIT are maternal-fetal safety, uterine relaxation to maintain uterine volume and uterus-placental circulation, and fetal immobility to help airway handling. We report one case of cervical teratoma managed successfully with EXIT procedure.
Authors:
Ferruh Bilgin; Nedim Cekmen; Yavuz Ugur; Ercan Kurt; Sadettin Güngör; Cuneyt Atabek
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Indian journal of anaesthesia     Volume:  53     ISSN:  0976-2817     ISO Abbreviation:  Indian J Anaesth     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2010-07-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0013243     Medline TA:  Indian J Anaesth     Country:  India    
Other Details:
Languages:  eng     Pagination:  678-82     Citation Subset:  -    
Affiliation:
Gülhane Military Medical Faculty, Department of Anesthesiology and Reanimation.
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