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Case series: Combined spinal epidural anesthesia for Cesarean delivery and ex utero intrapartum treatment procedure

[Série de cas : L’anesthésie rachidienne et péridurale combinée pour les interventions de césarienne et de traitement ex utero intrapartum]

From the Department of Anesthesiology, Women’s Anesthesia and Critical Care, Duke University Medical Center, Durham, North Carolina, USA.

Address correspondence to: Dr. Ronald B. George, Department of Anesthesiology, Women’s Anesthesia and Critical Care, Box 3094, Duke University Medical Center, Durham, NC 27710, USA. Phone: 919-668-6626; Fax: 919-668-6625; E-mail: ronald.george{at}duke.edu

Purpose: To report the use of regional anesthesia and iv nitroglycerin to provide anesthesia and uterine relaxation for three Cesarean deliveries (CD) involving ex utero intrapartum treatment (EXIT) of potentially life-threatening airway obstruction in the newborn.

Clinical features: Case 1 - a 36-yr-old woman at 38 weeks’ gestation was scheduled for an elective CD for fetal skeletal dysplasia and micrognathia. Case 2 - a 34-yr-old woman at 35 weeks gestation had a fetal ultrasound revealing fixed neck flexion and micrognathia consistent with fetal arthrogryposis. Case 3 - a 27-yr-old woman presented at 38 weeks gestation for CD for severe fetal micrognathia, with mandibular growth below the fifth percentile. For each case, a combined spinal epidural anesthetic was performed with 0.75% bupivacaine, fentanyl and morphine intrathecally followed by placement of a multiorifice epidural catheter. Prior to uterine incision patients received a loading dose followed by an iv infusion of nitroglycerin. Uterine relaxation was sufficient in all cases for delivery of the fetus, and allowed for evaluation by direct laryngoscopy and intubation while maintaining fetal-placental circulation. The surgical procedures were completed without incident.

Conclusions: Anesthesia and uterine relaxation for CD and EXIT procedures can be safely provided with regional anesthesia and iv nitroglycerin.

Related articles in CJA:

The ex utero intrapartum treatment (EXIT) procedure: maternal and fetal considerations/La procédure EXIT (ex utero intrapartum treatment) : considerations ftales et maternelles

Vinod Chinnappa and Stephen H. Halpern
CJA 2007 54: 171-175. [Full Text]  

This article has been cited by other articles:

				V. Chinnappa and S. H. Halpern The ex utero intrapartum treatment (EXIT) procedure: maternal and fetal considerations/La procedure EXIT (ex utero intrapartum treatment) : considerations foetales et maternelles Can J Anesth, March 1, 2007; 54(3): 171 - 175. [Full Text] [PDF]