ABSTRACT
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.
Subject(s)
Airway Obstruction/congenital , Anesthesia, Obstetrical/methods , Cesarean Section , Head and Neck Neoplasms/surgery , Intubation, Intratracheal , Oropharyngeal Neoplasms/surgery , Teratoma/surgery , Tracheostomy , Adult , Airway Obstruction/surgery , Anesthesia, Inhalation , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/pharmacology , Female , Head and Neck Neoplasms/complications , Head and Neck Neoplasms/congenital , Humans , Hysterotomy , Infant, Newborn , Methyl Ethers/administration & dosage , Methyl Ethers/pharmacology , Methylergonovine/pharmacology , Methylergonovine/therapeutic use , Oropharyngeal Neoplasms/complications , Oropharyngeal Neoplasms/congenital , Oxytocin/pharmacology , Oxytocin/therapeutic use , Placental Circulation , Polyhydramnios , Pregnancy , Sevoflurane , Teratoma/complications , Teratoma/congenital , Uterine Contraction/drug effectsABSTRACT
El procedimiento E.X.I.T. (Ex-Utero Intrapartum Treatment) proporciona un tiempo adecuado para conseguir el control de una vía aérea fetal potencialmente obstruida mientras se mantiene la circulación útero-placentaria durante la cesárea. Describimos dos casos clínicos de fetos con obstrucción congénita de la vía aérea alta en los que la estrategia E.X.I.T. permitió permeabilizar con éxito y sin complicaciones en la vía aérea. Además de tomarse las consideraciones generales de la paciente obstétrica y de realizarse anestesia fetal intramuscular, previamente a la histerotomía se administró sevofluorano a 1,5 CAM para conseguir una adecuada relajación uterina durante el procedimiento. Las dos gestantes permanecieron hemodinámicamente estables durante el procedimiento con una adecuada perfusión útero-placentaria. En un feto la intubación nasotraqueal fue posible tras disecar la masa cervical mientras que en el otro se realizó una traqueostomía. Tras el clampaje del cordón umbilical se redujo la concentración de halogenado y se administraron oxitocina y metilergometrina para conseguir una contracción uterina adecuada en pocos minutos. Ambos neonatos sobrevivieron al procedimiento sin complicaciones
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterectomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications
Subject(s)
Female , Pregnancy , Infant, Newborn , Adult , Humans , Cesarean Section , Airway Obstruction/congenital , Airway Obstruction/diet therapy , Anesthesia, Obstetrical/methods , Intubation, Intratracheal , Teratoma/surgery , Tracheotomy , Head and Neck Neoplasms/surgery , Oropharyngeal Neoplasms/surgery , Airway Obstruction/surgery , Anesthesia, Inhalation , Anesthetics, Inhalation/administration & dosage , Anesthetics, Inhalation/pharmacology , Hysterotomy , Methyl Ethers/administration & dosage , Methyl Ethers/pharmacology , Methylergonovine/pharmacology , Methylergonovine/therapeutic use , Oxytocin/pharmacology , Oxytocin/therapeutic use , Placental Circulation , Polyhydramnios , Teratoma/congenital , Teratoma/complications , Uterine Contraction , Head and Neck Neoplasms/congenital , Head and Neck Neoplasms/complications , Oropharyngeal Neoplasms/congenital , Oropharyngeal Neoplasms/complicationsABSTRACT
Although the etiology of Mondor's disease remains obscure, trauma of some form is the most commonly cited cause. Surgical trauma has frequently been quoted, but references in the literature specifically implicating aesthetic breast surgery are scarce. In this article, we report a case of Mondor's disease secondary to mastopexy with concomitant augmentation mammaplasty.
