Prosedur Ex Utero Intrapartum Treatment (EXIT) pada Janin dengan Fetal Cervical Teratoma: Laporan Kasus
Abstract
Prosedur Ex Utero Intrapartum Treatment (EXIT) adalah pendekatan operasi yang jarang dilakukan untuk menangani abnormalitas jalan napas pada neonatus. Prosedur ini bertujuan mempertahankan jalan napas dan oksigenasi janin melalui perfusi plasenta. Laporan ini bertujuan menjelaskan penerapan prosedur EXIT pada janin dengan fetal cervical teratoma, tantangan anestesi, dan penanganan kasus ini. Seorang wanita 27 tahun dengan usia gestasi 32 minggu didiagnosis dengan janin yang mengalami fetal cervical teratoma. Operasi dilakukan menggunakan anestesi umum dengan prosedur EXIT untuk mengamankan jalan napas neonatus. Setelah janin dilahirkan sebagian melalui operasi saesar, intubasi gagal akibat massa servikal besar yang menghalangi akses jalan napas. Meski oksigenasi plasenta dipertahankan selama 15 menit, bayi tidak dapat diselamatkan karena obstruksi jalan napas yang kompleks. Prosedur EXIT memerlukan persiapan intensif, kolaborasi lintas disiplin, dan strategi manajemen jalan napas yang matang. Pilihan anestesi umum mendukung relaksasi uterus maksimal untuk mempertahankan perfusi plasenta. EXIT adalah intervensi penting untuk memastikan pengamanan jalan napas pada janin dengan abnormalitas kongenital. Persiapan yang matang dan kolaborasi antar spesialis merupakan kunci keberhasilan prosedur ini.
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Lin EE, Moldenhauer JS, Tran KM, Cohen DE, Adzick NS. Anesthetic management of 65 cases of ex utero intrapartum therapy: a 13-year single-center experience. Anesth Analg. 2016;123(2):411-7. dOI: 10.1213/ANE.0000000000001385
Colin R.a B, Elizabeth F.a M, Pranavb P, Richarda H. Ex utero intrapartum treatment (EXIT) for upper airway obstruction. Current Opinion in Otolaryngology & Head and Neck Surgery . 2017 Apr;25(2):119–26.
García-Díaz L, Chimenea A, de Agustín JC, Pavón A, Antiñolo G. Ex-Utero Intrapartum Treatment (EXIT): Indications and Outcome in Fetal Cervical and Oropharyngeal Masses. BMC Pregnancy Childbirth. 2020;20(123):1–8.
Bence CM, Wagner AJ. Ex utero intrapartum treatment (EXIT) procedures. Semin Pediatr Surg. 2019;28(4): 150820. 10.1053/j.sempedsurg.2019.07.003.
Nolan HR, Gurriá J, Peiro JL, Tabbah S, Diaz-Primera R, Polzin W, et al. Congenital high airway obstruction syndrome (CHAOS): Natural history, prenatal management strategies, and outcomes at a single comprehensive fetal center. J Pediatr Surg. 2019;54(6):1153–158. Doi: doi: 10.1016/j.jpedsurg.2019.02.034
Taghavi K, Beasley S. The Ex Utero Intrapartum Treatment (EXIT) procedure: Application of a new Ttherapeutic paradigm. J Paediatr Child Health. 2013 Oct;49(9):E420–7.
Doi: 10.1111/jpc.12223.
Sutton CD, Olutoye OA. Anesthesia for ex utero intrapartum therapy. Dalam: J Pediatr Surg. 2nd ed. Oxford: Oxford Academic; 2018, 335–42. Doi:10.1093/MED/9780190678333.003.0052
Oliveira E, Pereira P, Retroz C, Mártires E. Anesthesia for EXIT procedure (ex utero intrapartum treatment) in congenital cervical malformation—a challenge to the anesthesiologist. Braz J Anesthesiol. 2015;65(6):529–33. Doi: 10.1016/j.bjane.2013.07.020
Luo D, Wu L, Wu H, Yu J. Anesthetic management of a neonate receiving prenatal repair of gastroschisis. Int J Clin Exp Med. 2015;8(5):8234-7.
Braden A, Maani C, Nagy C. Anesthetic management of an ex utero intrapartum treatment procedure: a novel balanced approach. J Clin Anesth. 2016;31(4):60-3. Doi: https://doi.org/10.1016/j.jclinane.2015.12.010
Marques MV, Carneiro J, Adriano M, Nogueira I, Lança F. Anesthesia for ex utero intrapartum treatment: renewed insight on a rare procedure. Rev Bras Anestesiol. 2015;65(5):525-8. Doi: 10.1016/j.bjane.2013.12.002
Ogunyemi D, Koutouzis TO. Ex Utero Intrapartum Treatment (EXIT) [Internet]. StatPearls Publishing. 2023 [cited 2024 Nov 21]. Tersedia dari: https://www.ncbi.nlm.nih.gov/books/NBK604209/
Domínguez-Moreno M, Chimenea Á, Viegas-González MR, Morales-Muñoz C, García-Díaz L, Antiñolo G. A detailed exploration of the Ex Utero Intrapartum Treatment procedure with center-specific advancements. Surg Tech Dev. 2024;13:76-86. Doi: 10.3390/std13010005
Kavya UR, Laxmi S, Ramkumar V. Effect of intravenous dexmedetomidine administered as bolus or as bolus-plus-infusion on subarachnoid anesthesia with hyperbaric bupivacaine. J Anaesthesiol Clin Pharmacol. 2018;34(1):46-50. Doi: 10.4103/joacp.JOACP_132_16
Jardine A, Welantika BL, Fitriati M, Wardhana MP. Anesthetic consideration for ex-utero intrapartum treatment procedure: A case series. Bali J Anaesthesiol. 2023;7(3):173-6. Doi: DOI:10.4103/bjoa.bjoa_98_23
Chimenea Á, Domínguez-Moreno M, Viegas-González MR, Morales-Muñoz C, García-Díaz L, Antiñolo G. Anesthetic considerations for the ex utero intrapartum treatment procedure: A review of fetal and maternal outcomes. BMC Pregnancy Childbirth. 2020;20(3304):1-12.
Spiers A, Legendre G, Biquard F, Descamps P, Corroenne R. Ex utero intrapartum technique (EXIT): Indications, procedure methods and materno-fetal complications – A literature review. J Gynecol Obstet Hum Reprod. 2022 ;51(1): 102252. Doi: 10.1016/j.jogoh.2021.102252
Novoa RH, Quintana W, Castillo-Urquía W, Ventura W. EXIT (ex utero intrapartum treatment) surgery for the management of fetal airway obstruction: A systematic review of the literature. J Pediatr Surg. 2020;55(7):1188–195. Doi: 10.1016/j.jpedsurg.2020.02.011
Helfer DC, Clivatti J, Yamashita AM, Rosa DF, Silva LA, Cardoso M. Anesthesia for ex utero intrapartum treatment (EXIT procedure) in fetus with prenatal diagnosis of oral and cervical malformations: case reports. Rev Bras Anestesiol. 2012;62(3):411–23. Doi: Doi:10.1016/S0034-7094(12)70141-1.
Silva M. Ex utero intrapartum treatment (EXIT) procedure: Indications and procedural considerations. J Perioperativ Nurs. 2019;32(4):9–19. Doi: 10.26550/2209-1092.1068
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Jurnal Anestesi Obstetri Indonesia
