TITLE:
The use of remifentanil in ex utero intrapartum treatment procedures
AUTHORS:
Chad Whited, Eileen Raynor
KEYWORDS:
EXIT; Ex Utero Intrapartum Treatment Procedure; Remifentanil; Airway
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.3 No.4,
November
28,
2013
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.