Report of a case: the anesthetic management for fetal tracheal intubation with intact uteroplacental circulation during cesarean section

We experienced a case of cesarean section in a patient with a fetus having a prenatally diagnosed huge cervical mass, which could cause airway obstruction immediately after delivery. The fetal cervical mass was confirmed at 19 gestational weeks, and amniocentesis was performed at 33 weeks. At 35 weeks, MRI showed the large mass that could disturb the airway patency after birth, and elective cesarean section was scheduled at 37 weeks. In the anesthetic management, anesthesia was maintained with isoflurane in oxygen, and ritodorine and nitroglycerin were used for obtaining uterine relaxation and keeping uteroplacental circulation. Fetal head was exposed from the uterine incision site and tracheal intubation was successfully performed. After confirming the neonatal oxygenation under manual ventilation, the baby was delivered. After delivery, the mass was diagnosed as cystic hygroma and he was maintained under mechanical ventilation in NICU. Five months later subtotal excision of the cervical cystic hygroma and tracheostomy were performed.