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[Ex utero intrapartum technique].
Minerva Anestesiol. 2004 May; 70(5):379-85.MA

Abstract

Upper airway obstruction of a neonate constitutes an emergency. The ex utero intrapartum technique (EXIT) is a procedure for safely managing airway obstruction at birth, in which placental support is maintained until the airway is evaluated and secured. The anaesthetist is involved in preventing uterine contractions that impair oxygenation of the foetus and cause placental separation, in providing foetal anaesthesia to help airway manipulations, in maintaining foetal pattern of circulation, in preventing and treating maternal hypotension and in resuscitating the neonate. General anaesthesia with high concentration of inhalational agents is preferred as it provides surgical tocolysis and foetal anaesthesia. Additional uterine relaxation may be obtained using tocolytic drugs like nitroglycerin or beta-adrenergic agonists. During EXIT the foetus is delivered only as far as the shoulders or thorax leaving the cord entirely in utero to maximize the duration of placental support and to minimize heat and water loss. In this position foetal airway is examined and secured, which may involve tracheal intubation, bronchoscopy or tracheostomy. The umbilical cord is divided and the neonate is completely delivered only after the airway has been secured. With EXIT, a potential life-threatening emergency at birth can be managed like an elective procedure that can improve the prognosis for foetuses with airway obstruction.

Authors+Show Affiliations

Dipartimento di Anestesia e Rianimazione, Azienda, Ospedaliera Padova, Padova, Italy. nicola.zadra@sanita.padova.itNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

English Abstract
Journal Article
Review

Language

ita

PubMed ID

15181419

Citation

Zadra, N, et al. "[Ex Utero Intrapartum Technique]." Minerva Anestesiologica, vol. 70, no. 5, 2004, pp. 379-85.
Zadra N, Meneghini L, Midrio P, et al. [Ex utero intrapartum technique]. Minerva Anestesiol. 2004;70(5):379-85.
Zadra, N., Meneghini, L., Midrio, P., & Giusti, F. (2004). [Ex utero intrapartum technique]. Minerva Anestesiologica, 70(5), 379-85.
Zadra N, et al. [Ex Utero Intrapartum Technique]. Minerva Anestesiol. 2004;70(5):379-85. PubMed PMID: 15181419.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Ex utero intrapartum technique]. AU - Zadra,N, AU - Meneghini,L, AU - Midrio,P, AU - Giusti,F, PY - 2004/6/8/pubmed PY - 2005/2/5/medline PY - 2004/6/8/entrez SP - 379 EP - 85 JF - Minerva anestesiologica JO - Minerva Anestesiol VL - 70 IS - 5 N2 - Upper airway obstruction of a neonate constitutes an emergency. The ex utero intrapartum technique (EXIT) is a procedure for safely managing airway obstruction at birth, in which placental support is maintained until the airway is evaluated and secured. The anaesthetist is involved in preventing uterine contractions that impair oxygenation of the foetus and cause placental separation, in providing foetal anaesthesia to help airway manipulations, in maintaining foetal pattern of circulation, in preventing and treating maternal hypotension and in resuscitating the neonate. General anaesthesia with high concentration of inhalational agents is preferred as it provides surgical tocolysis and foetal anaesthesia. Additional uterine relaxation may be obtained using tocolytic drugs like nitroglycerin or beta-adrenergic agonists. During EXIT the foetus is delivered only as far as the shoulders or thorax leaving the cord entirely in utero to maximize the duration of placental support and to minimize heat and water loss. In this position foetal airway is examined and secured, which may involve tracheal intubation, bronchoscopy or tracheostomy. The umbilical cord is divided and the neonate is completely delivered only after the airway has been secured. With EXIT, a potential life-threatening emergency at birth can be managed like an elective procedure that can improve the prognosis for foetuses with airway obstruction. SN - 0375-9393 UR - https://www.unboundmedicine.com/medline/citation/15181419/[Ex_utero_intrapartum_technique]_ L2 - http://www.minervamedica.it/index2.t?show=R02Y2004N05A0379 DB - PRIME DP - Unbound Medicine ER -