Kern C, Ange M, Peiry B, Pfister R E
Anaesthesia, University Hospital Geneva, Switzerland.
Swiss Med Wkly. 2007 May 19;137(19-20):279-85. doi: 10.4414/smw.2007.11526.
The ex utero intrapartum treatment (EXIT) procedure is designed to guarantee sufficient oxygenation for a foetus at risk of airway obstruction. This is achieved by improving lung ventilation, usually by establishing an airway during caesarean delivery whilst preserving the foetal-placental circulation temporarily. Indications for the EXIT procedure have extended from its original use in reversing iatrogenic tracheal obstruction in congenital diaphragmatic hernia to naturally occurring upper airway obstructions. We report our experience with a new and rarely mentioned indication for the EXIT procedure, intra-thoracic volume expansions. The elaboration of lowest risk scenarios through balancing risks with alternative options, foetal or neonatal intervention and coordination between professionals from various disciplines are the most important conditions for a successful EXIT procedure. The EXIT procedure requires a caesarean section that specifically differs from the traditional caesarean section during which uterine tone is maintained to minimize maternal bleeding. To guarantee foetal oxygenation during the EXIT procedure, profound uterine relaxation is desired. To gain time with optimal placental oxygenation in order to safely perform an airway intervention in a baby at risk of hypoxia may require deep inhalation anaesthesia and/or tocolytic agents. We review the EXIT procedure and present a case series from the University Hospital of Geneva that contrasts with the common indication for the EXIT procedure usually based on upper airway obstruction by its exclusive indication for intra-thoracic malformations/diseases.
产时宫外治疗（EXIT）程序旨在确保存在气道阻塞风险的胎儿获得足够的氧合。这通常通过改善肺通气来实现，即在剖宫产过程中建立气道，同时暂时维持胎儿 - 胎盘循环。EXIT程序的适应证已从最初用于纠正先天性膈疝的医源性气管阻塞扩展到自然发生的上呼吸道阻塞。我们报告了EXIT程序一种新的且很少被提及的适应证——胸腔容积扩张的经验。通过权衡风险与替代方案、胎儿或新生儿干预以及各学科专业人员之间的协调来制定最低风险方案，是EXIT程序成功的最重要条件。EXIT程序需要进行剖宫产，这与传统剖宫产不同，传统剖宫产要维持子宫张力以尽量减少母体出血。为了在EXIT程序中保证胎儿氧合，需要深度子宫松弛。为了争取最佳胎盘氧合时间，以便在有缺氧风险的婴儿中安全地进行气道干预，可能需要深度吸入麻醉和/或宫缩抑制剂。我们回顾了EXIT程序，并展示了日内瓦大学医院的一系列病例，这些病例与EXIT程序通常基于上呼吸道阻塞的常见适应证形成对比，其唯一适应证是胸腔畸形/疾病。
