Kai Tetsuya, Ishibe Natsuki, Soeda Yuji, Tanaka Mariko, Hoka Sumio
Masui. 2015 Apr;64(4):373-8.
We successfully managed two fetuses complicated with suspected airway obstruction after birth by the EXIT (ex utero intrapartum treatment) procedure, whose placental circulation was maintained till their airway was secured during the cesarean section. The first fetus was suspected to have airway obstruction due to a large neck mass. At 36 weeks of gestation, the EXIT procedure was undertaken performing the tracheal intubation successfully by laryngoscope. The second fetus with micrognathia was expected to have airway obstruction after birth. The EXIT procedure was undertaken at 35 weeks of gestation. The tracheal intubation by laryngoscope or by stylet scope was impossible, and the airway was secured by tracheostomy. The direct roles of anesthesiologists in the EXIT procedure are to let the uterus relax enough, deal with bleeding, and manage the fetal airway. The EXIT procedure is a specialized operation in which various specialists are involved, and a variety of judgments are necessary within a short time. Therefore, all concerned personnel should discuss previously to make a concensus on the processes during the procedure. The organization may be also an important role of the anesthesiologists in the EXIT procedure.
我们通过产时宫外治疗（EXIT）手术成功处理了两例出生后疑似气道阻塞的胎儿，在剖宫产过程中维持其胎盘循环直至气道安全。首例胎儿因颈部巨大肿块疑似气道阻塞。妊娠36周时，实施EXIT手术，通过喉镜成功进行气管插管。第二例小颌畸形胎儿预计出生后气道阻塞。妊娠35周时实施EXIT手术。无法通过喉镜或探条式喉镜进行气管插管，通过气管切开确保气道安全。麻醉医生在EXIT手术中的直接作用是使子宫充分松弛、处理出血并管理胎儿气道。EXIT手术是一项涉及多专科医生的特殊手术，需要在短时间内做出各种判断。因此，所有相关人员应提前讨论，就手术过程达成共识。在EXIT手术中，组织协调可能也是麻醉医生的一项重要职责。
