The use of remifentanil in ex utero intrapartum treatment procedures ()
Abstract
Purpose: We propose that using remifentanil in ex
utero intrapartum treatment (EXIT) procedures reduces the need for maternal
exposure to general anesthesia. Using remifentanil along with spinal anesthesia
eliminates the fetal and maternal risks associated with inhalational general
anesthesia, allows the mother to be awake, and obviates the need for and costs
associated with general anesthesia and a second anesthesia team. Materials and
Methods: We performed a retrospective review of all sequential patients
undergoing ex utero intrapartum treatment procedure at our hospital from 1/1/2009 to 11/1/2010. All procedures were performed under regional neuraxial analgesia,
using nitroglycerine as a tocolytic agent and remifentanil for analgesia.
Variables included indication, time to secured fetal airway, complications,
estimated blood loss, need for additional anesthetics, participating personnel,
and survival. Results: All five of our ex utero intrapartum treatment procedures
were successfully completed with combined spinal epidural remifentanil
anesthetic. No patient was required additional alternative anesthetic. There
were no complications with mother or fetus. Indications for procedure were
arthyrogryposis (n = 3), fetal goiter, and micrognathia. Average time to
secured airway was 10.25 minutes. Average estimated blood loss was 1010 ml. All
five mothers were conscious during their procedure. Conclusions: We report the
largest series of ex utero intrapartum treatment procedures performed with
remifentanil regional anesthesia. We found that the combined use of
nitroglycerin and regional remifentanil anesthesia is a safe alternative to the
pediatric otolaryngologist for performing ex utero intrapartum treatment procedures
without the risks of general anesthesia, allowing the mother to be awake for
the delivery, and reducing the cost of providing care.
Share and Cite:
Whited, C. and Raynor, E. (2013) The use of remifentanil in ex utero intrapartum treatment procedures.
Open Journal of Pediatrics,
3, 366-369. doi:
10.4236/ojped.2013.34066.
Conflicts of Interest
The authors declare no conflicts of interest.
References
|
[1]
|
Catalano, P., Urken, M.L., Alvarez, M., et al. (1992) New approach to the management of airway obstruction in “High Risk” neonates. Archives of Otolaryngology—Head and Neck Surgery, 118, 306-309.
http://dx.doi.org/10.1001/archotol.1992.01880030094019
|
|
[2]
|
Bouchard, S., Johnson, M., Flake, A., et al. (2002) The EXIT procedure: Experience and Outcome in 31 cases. Journal of Pediatric Surgery, 3, 418-426.
http://dx.doi.org/10.1053/jpsu.2002.30839
|
|
[3]
|
Hirose, S., Farmer, D., Lee, H., Nobuhara, K.K. and Harrison, M.R. (2009) The ex utero intrapartum treatment procedure: Looking back at the EXIT. Journal of Pediatric Surgery, 39, 375-380.
http://dx.doi.org/10.1016/j.jpedsurg.2003.11.011
|
|
[4]
|
Hill, D. (2008) The use of remifentanil in obstetrics. Anesthesiology Clinics, 26, 169-182.
|
|
[5]
|
Clark, K., Viscomi, C., Lowell, J. and Chien, E.K. (2004) Nitroglycerin for relaxation to establish a fetal airway (EXIT procedure). Obstetrics & Gynecology, 103, 1113-1115.
http://dx.doi.org/10.1097/01. AOG.0000125158.61232.b3
|
|
[6]
|
Egan, T.D. (2000) Pharmacokinetics and pharmacodynamics of remifentanil: An update in the year 2000. Current Opinion in Anaesthesiology, 13, 449-455.
http://dx.doi.org/10.1097/00001503-200008000-00009
|
|
[7]
|
Kan, R.E., Hughes, S.C., Rosen, M.A., Kessin, C., Preston, P.G. and Lobo, E.P. (1998) Intravenous remifentanil: Placental transfer, maternal and neonatal effects. Anesthesiology, 88, 1467-1474.
http://dx.doi.org/10.1097/00000542-199806000-00008
|