Anesthetic considerations of EXIT procedure: A case report

Area of Science:

• Medical Science
• Surgical Procedures
• Anesthesiology

Background:

• The ex-utero intrapartum treatment (EXIT) procedure is a specialized surgical intervention for anticipated fetal airway obstruction.
• It ensures a patent fetal airway during labor without disrupting maternal-fetal circulation.
• Anesthetic management for EXIT procedures differs significantly from standard cesarean deliveries, prioritizing uterine relaxation, fetal anesthesia, and placental perfusion.

Observation:

• This case report describes the first EXIT procedure performed at King Khalid University Hospital, Riyadh, Saudi Arabia.
• The procedure was indicated for a fetus diagnosed prenatally with multiple oral masses.
• The EXIT procedure facilitated the establishment of a fetal airway in anticipation of critical respiratory compromise.

Findings:

• Successful application of the ex-utero intrapartum treatment (EXIT) procedure in a complex fetal anomaly case.
• Demonstration of effective anesthetic management for uterine relaxation, fetal anesthesia, and placental blood flow preservation during the EXIT procedure.
• Establishment of a patent fetal airway, crucial for immediate postnatal respiratory support.

Implications:

• Highlights the utility of the EXIT procedure in managing rare fetal conditions causing airway obstruction.
• Provides valuable insights into the anesthetic considerations for EXIT procedures in complex fetal cases.
• Contributes to the understanding and application of advanced fetal surgical interventions in Saudi Arabia.