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Delivery of an Infant with Airway Compression Due to Cystic Hygroma at 37 Weeks' Gestation Requiring a Multidisciplinary Decision to Use a Combination of Ex Utero Intrapartum Treatment (EXIT) and Airway Palliation at Cesarean Section

Diagnostic / therapeutic accidents, Unusual setting of medical care, Congenital defects / diseases

Joel Sirianni, Joseph Abro, David Gutman

USA Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, SC, USA

Am J Case Rep 2021; 22:e927803

DOI: 10.12659/AJCR.927803

Available online: 2020-11-19

Published: 2021-01-03


#927803

BACKGROUND: This report describes a case of delivery of an infant with airway compression due to cystic hygroma at 37 weeks’ gestation requiring a multidisciplinary decision to use a combination of ex utero intrapartum treatment (EXIT) and airway palliation at cesarean section. This infant did not require support with extracorporeal membrane oxygenation (ECMO).
CASE REPORT: A 22-year-old G1P0 woman with past medical history of morbid obesity underwent an EXIT procedure due to a large fetal neck mass. Anesthesia included a narcotic-only single-shot spinal, total intravenous anesthesia (TIVA) was used for maintenance, and high-dose volatile anesthetics and nitroglycerin infusion was used for complete uterine relaxation. The infant’s airway was secured by the otolaryngologist, after which delivery was completed. Sevoflurane and nitroglycerin were discontinued and the previous TIVA was restarted. Uterotonics were aggressively administered to prevent uterine atony, and the patient was extubated.
CONCLUSIONS: This report shows the importance of a multidisciplinary approach to the management of delivery of infants with airway obstruction. This case demonstrates the approach to the decision for the use of EXIT combined with airway palliation, as ECMO was not combined with EXIT in this case.

Keywords: Cesarean Section, Extracorporeal Membrane Oxygenation, Intubation, Intratracheal, Lymphangioma, Cystic, Magnetic Resonance Imaging, Obstetric Surgical Procedures



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