ABSTRACT
Ex utero intrapartum treatment (EXIT) procedures are therapeutic interventions for fetuses with life-threatening airway abnormalities and/or other prenatally diagnosed congenital malformations requiring immediate neonatal extracorporeal membrane oxygenation support. Although certain anesthetic goals are common among EXIT procedures, many different approaches to their management have been described in the literature. Herein, we present a novel anesthetic approach to an EXIT procedure for fetal micrognathia and retrognathia. We also review the indications and anesthetic considerations for these procedures and highlight the need for multidisciplinary collaboration to optimize clinical outcomes.
Subject(s)
Airway Obstruction/therapy , Anesthesia, Obstetrical/methods , Cesarean Section/methods , Fetal Diseases/therapy , Perinatal Care/methods , Airway Obstruction/etiology , Anesthesia, General/methods , Female , Fetal Diseases/diagnostic imaging , Humans , Infant, Newborn , Magnetic Resonance Imaging , Micrognathism/complications , Micrognathism/diagnostic imaging , Micrognathism/therapy , Pregnancy , Prenatal Diagnosis/methods , Retrognathia/complications , Retrognathia/diagnostic imaging , Retrognathia/therapy , Young AdultABSTRACT
BACKGROUND: Invasive mucormycosis or aspergillosis is a life-threatening infection. The disease typically occurs in immunocompromised patients (e.g., those with diabetes mellitus or burns) but is rarely serious in otherwise-healthy young trauma patients. METHODS: Case report and literature review. RESULTS: A previously-healthy 22-year-old United States Marine who sustained large soft tissue injuries in support of Operation Enduring Freedom underwent multiple operations in theater to stabilize his wounds. He was evacuated first to Landstuhl Regional Medical Center in Germany and thence to the National Naval Medical Center in Maryland, where appropriate antifungal therapies were initiated and wide débridements were undertaken without success. His clinical status deteriorated, and he died. Tissue examination revealed systemic invasive mucormycosis and aspergillosis. CONCLUSION: The suspicion of invasive fungal infections must be tested early if intervention is to be curative.
