OJPed  Vol.3 No.4 , December 2013
The use of remifentanil in ex utero intrapartum treatment procedures
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.
Cite this paper: Whited, C. and Raynor, E. (2013) The use of remifentanil in ex utero intrapartum treatment procedures. Open Journal of Pediatrics, 3, 366-369. doi: 10.4236/ojped.2013.34066.

[1]   Catalano, P., Urken, M.L., Alvarez, M., et al. (1992) New approach to the management of airway obstruction in “High Risk” neonates. Archives of Otolaryngology—Head and Neck Surgery, 118, 306-309.

[2]   Bouchard, S., Johnson, M., Flake, A., et al. (2002) The EXIT procedure: Experience and Outcome in 31 cases. Journal of Pediatric Surgery, 3, 418-426.

[3]   Hirose, S., Farmer, D., Lee, H., Nobuhara, K.K. and Harrison, M.R. (2009) The ex utero intrapartum treatment procedure: Looking back at the EXIT. Journal of Pediatric Surgery, 39, 375-380.

[4]   Hill, D. (2008) The use of remifentanil in obstetrics. Anesthesiology Clinics, 26, 169-182.

[5]   Clark, K., Viscomi, C., Lowell, J. and Chien, E.K. (2004) Nitroglycerin for relaxation to establish a fetal airway (EXIT procedure). Obstetrics & Gynecology, 103, 1113-1115. AOG.0000125158.61232.b3

[6]   Egan, T.D. (2000) Pharmacokinetics and pharmacodynamics of remifentanil: An update in the year 2000. Current Opinion in Anaesthesiology, 13, 449-455.

[7]   Kan, R.E., Hughes, S.C., Rosen, M.A., Kessin, C., Preston, P.G. and Lobo, E.P. (1998) Intravenous remifentanil: Placental transfer, maternal and neonatal effects. Anesthesiology, 88, 1467-1474.