The experience of respiratory management in 20 cases of fetuses undergoing ex utero intrapartum treatment surgery / 中国小儿急救医学

ABSTRACT

Objective:To summarize the experience of respiratory management in 20 cases of fetuses diagnosed with prenatal malformations undergoing ex utero intrapartum treatment (EXIT) surgery.Methods:From 2016 to 2018, 20 cases of fetuses undergoing EXIT surgery were admitted to our hospital, including five cases of maxillofacial lymphangioma, four cases of cervical teratoma, three cases of lung cystadenoma, five cases of pleural effusion, and three cases of isolated lung.The fetal anesthesia was through maternal anesthesia.After the fetal head was delivered, the placental circulation was maintained.All cases were established with artificial laryngoscopy by visual laryngoscopy and tracheal intubation.The blood oxygen saturation and heart rate of the fetuses were recorded before and after intubation.After successful intubation, the umbilical cord was broken and the fetal arterial blood gas was drawn.Immediately, the neonatal surgery was performed in the delivery room, with 3 to 5 cmH 2O(1 cmH 2O=0.098 kPa) PEEP for respiratory support, and blood gas analysis during the operation were collected.After surgery, newborns were transferred to NICU. Results:(1) The 20 cases of fetal anesthesia under placenta maintenance, maternal 1.5 MAC sevoflurane inhalation anesthesia with remifentanil pumping, fetal oxygen saturation can be maintained at (51.5±4.7)%, fetal heart rate (155.3± 11.34) times/min; (2) The completion time of tracheal intubation of 20 fetuses was (24.20±3.43)s, the time of glottal exposure was (3.20 ±1.12)s, and the success rate of one intubation was 90% (18/20), of which two cases were exposed to glottis difficult, successful after two tracheal intubation; (3) The use of 3 to 5 cmH 2O PEEP to support the high-frequency positive pressure ventilation mode can provide good oxygenation[SpO 2 (92.10±3.34)%] during the neonatal surgery, the length of hospital stay of the fetus was (15.0±3.2) d, and ventilator duration time was (3.0±1.2) d. Postoperative complications included four cases of pneumonia and two cases of atelectasis. Conclusion:(1) Avoiding excessive deep anesthesia of mother, maintain the placental circulation effectively, providing good oxygenation before artificial airway establishment and providing effective anesthesia for the fetus are important in EXIT; (2) The visual laryngoscope shortens the intubation time, and the glottis is well exposed, which can increase the oxygenation index of the newborn after the umbilical cord is broken; (3) The high-frequency ventilation mode supported by PEEP can provide good oxygenation for newborns during surgery.