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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(03): 214-219
DOI: 10.1055/s-0042-105986
Topthema
Georg Thieme Verlag KG Stuttgart · New York

Geburtshilfe: Anästhesie bei EXIT-Prozedur

Alexander Torossian
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Publication History

Publication Date:
16 March 2017 (online)

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Zusammenfassung

Die Ex-utero-Intrapartum-Treatment-(EXIT-)Prozedur wird im Rahmen einer erweiterten Sectio caesarea beispielsweise bei fetaler Atemwegsanomalie durchgeführt. Dazu ist die Aufrechterhaltung der uteroplazentaren Versorgung des Feten bei optimaler Uterusrelaxation erforderlich. Eine „balancierte“ Anästhesie, Tokolyse und maternale arterielle Blutdruckeinstellung in engen Grenzen wird empfohlen. Das fetale Standardmonitoring umfasst dabei die Pulsoxymetrie und Echokardiografie. Es werden die physiologischen Besonderheiten und anästhesiologischen Ziele der EXIT-Prozedur und Möglichkeiten der Anästhesieführung dargestellt sowie ein Ausblick auf mögliche Neuerungen gegeben.

Abstract

The ex utero intrapartum treatment (EXIT) procedure is performed as a part of an extended caesarean section for example to treat fetal airway disorders. For treatment, optimal uterine relaxation is necessary, however utero-placental supply of the fetus has to be guaranteed as well. “Balanced” anesthesia, tocolysis and tight maternal arterial blood pressure control are recommended. Standard fetal monitoring comprises pulse oxymetry and echocardiography. The article describes the physiology and anesthestic goals of the EXIT procedure, discusses alternative anesthesia techniques and gives an outlook on emerging progress.

Kernaussagen

  • Die EXIT-Prozedur (= Ex Utero Intrapartum Treatment) wird im Rahmen einer erweiterten Sectio caesarea beispielsweise bei fetaler Atemwegsanomalie durchgeführt. Dazu ist die Aufrechterhaltung der uteroplazentaren Versorgung des Feten bei optimaler Uterusrelaxation erforderlich. Eine „balancierte“ Anästhesie, Tokolyse und maternale arterielle Blutdruckeinstellung in engen Grenzen wird empfohlen. Das fetale Standardmonitoring umfasst dabei die Pulsoxymetrie und Echokardiografie.

  • Ziele während der EXIT-Prozedur sind:

    • Aufrechterhaltung der uteroplazentaren Zirkulation

    • kontrollierte uterine Hypotension (komplette Relaxation)

    • kontinuierliches fetales Monitoring

    • Aufrechterhaltung des uterinen Volumens

Schlüsselwörter

EXIT Prozedur - uteroplazentarer Blutfluss - Anästhesieführung bei EXIT - fetales Monitoring

Key words

EXIT procedure - utero-placental blood flow - anesthesia for EXIT - fetal monitoring
 

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