RESUMEN
Recessive dystrophic epidermolysis bullosa is inherited as a rare autosomal disorder which causes blisters to form in the skin. We describe the treatment of a 39-year-old parturient with this condition. She was scheduled for elective cesarean section at 37 weeks' gestation. The patient had widespread skin lesions, had lost fingers, and had esophageal stenosis. The cesarean was performed under spinal anesthesia without complications. Recessive dystrophic epidermolysis bullosa requires adaptation of anesthetic technique that includes control over posture and careful handling of the skin. Material for attaching monitoring devices and inserting venous lines must be adapted to the particular deformities and skin lesions present.
Asunto(s)
Anestesia Obstétrica/métodos , Anestesia Raquidea/métodos , Cesárea , Epidermólisis Ampollosa Distrófica , Complicaciones del Embarazo , Adulto , Epidermólisis Ampollosa Distrófica/complicaciones , Estenosis Esofágica/etiología , Femenino , Humanos , Recién Nacido , Complicaciones Intraoperatorias/prevención & control , Complicaciones Posoperatorias/prevención & control , Postura , EmbarazoRESUMEN
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.
Asunto(s)
Obstrucción de las Vías Aéreas/congénito , Anestesia Obstétrica/métodos , Cesárea , Neoplasias de Cabeza y Cuello/cirugía , Intubación Intratraqueal , Neoplasias Orofaríngeas/cirugía , Teratoma/cirugía , Traqueostomía , Adulto , Obstrucción de las Vías Aéreas/cirugía , Anestesia por Inhalación , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/farmacología , Femenino , Neoplasias de Cabeza y Cuello/complicaciones , Neoplasias de Cabeza y Cuello/congénito , Humanos , Histerotomía , Recién Nacido , Éteres Metílicos/administración & dosificación , Éteres Metílicos/farmacología , Metilergonovina/farmacología , Metilergonovina/uso terapéutico , Neoplasias Orofaríngeas/complicaciones , Neoplasias Orofaríngeas/congénito , Oxitocina/farmacología , Oxitocina/uso terapéutico , Circulación Placentaria , Polihidramnios , Embarazo , Sevoflurano , Teratoma/complicaciones , Teratoma/congénito , Contracción Uterina/efectos de los fármacosRESUMEN
El procedimiento E.X.I.T. (Ex-Utero Intrapartum Treatment) proporciona un tiempo adecuado para conseguir el control de una vía aérea fetal potencialmente obstruida mientras se mantiene la circulación útero-placentaria durante la cesárea. Describimos dos casos clínicos de fetos con obstrucción congénita de la vía aérea alta en los que la estrategia E.X.I.T. permitió permeabilizar con éxito y sin complicaciones en la vía aérea. Además de tomarse las consideraciones generales de la paciente obstétrica y de realizarse anestesia fetal intramuscular, previamente a la histerotomía se administró sevofluorano a 1,5 CAM para conseguir una adecuada relajación uterina durante el procedimiento. Las dos gestantes permanecieron hemodinámicamente estables durante el procedimiento con una adecuada perfusión útero-placentaria. En un feto la intubación nasotraqueal fue posible tras disecar la masa cervical mientras que en el otro se realizó una traqueostomía. Tras el clampaje del cordón umbilical se redujo la concentración de halogenado y se administraron oxitocina y metilergometrina para conseguir una contracción uterina adecuada en pocos minutos. Ambos neonatos sobrevivieron al procedimiento sin complicaciones
An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterectomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications
