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Multimodal general anesthesia approach for Ex Utero Intrapartum Therapy (EXIT) procedures: two case reports
Affiliation:1. Division of Otolaryngology, Children''s National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010, United States;2. Walter Reed National Military Medical Center, Bethesda, MD 20889, United States;3. Division of Anesthesia, 111 Michigan Ave., NW, Washington, DC 20010, United States;4. Division of Diagnostic Imaging and Radiology, Children''s National Medical Center, 111 Michigan Avenue, NW, Washington, DC 20010, United States;1. The Children''s Hospital of Philadelphia, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA;2. Department of Pediatric Surgery, University Children''s Hospital Zurich, Zurich, Switzerland;1. Vascular Birthmark Institute of New York, Head and Neck Institute, Lenox Hill Hospital, 150 East 77th Street, New York, NY 10075, USA;2. Department of Otolaryngology–Head and Neck Surgery, Vascular Birthmark Institute of New York, Facial Nerve Center, Manhattan Eye, Ear and Throat Hospital, 210 East 64th Street, 7 Floor, New York, NY 10065, USA;1. Fetal Intervention Team, University of Texas Southwestern Medical Center, Dallas, Texas;2. Division of Pediatric Surgery, Department of Surgery, University of Texas Southwestern Medical Center, Children''s Medical Center, Dallas, Texas
Abstract:High-dose volatile anesthesia is the most common method of achieving uterine relaxation for Ex Utero Intrapartum Therapy (EXIT) procedures. Other methods employ nitroglycerin for additional uterine relaxation with or without remifentanil for additional fetal analgesia. We report a combination approach including one minimum alveolar concentration of volatile anesthetic plus nitroglycerin and remifentanil infusions, to provide timely uterine relaxation under general anesthesia for both mother and fetus, during two EXIT procedures.
Keywords:Ex Utero Intrapartum Therapy  General anesthesia  Regional anesthesia  Transversus abdominis plane block
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