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.

Abstract

Patient: Female, 22-year-oldFinal Diagnosis: Central line infection • cystic hygroma • pregnancySymptoms: Cystic hygroma • neck mass • pregnancyMedication: —Clinical Procedure: Cesarean section • ex utero intrapartum treatment • fiberoptic bronchoscopy • general anesthesia • laryngoscopy • rigid bronchoscopy • spinal anesthesia • video laryngoscopySpecialty: Anesthesiology • Obstetrics and Gynecology • OtolaryngologyObjective:Congenital defects/diseasesBackground: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.