PMID- 27684833
OWN - NLM
STAT- MEDLINE
DCOM- 20170217
LR  - 20220331
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 95
IP  - 39
DP  - 2016 Sep
TI  - Use of the GlideScope video laryngoscope for intubation during ex utero 
      intrapartum treatment in a fetus with a giant cyst of the 4th branchial cleft: A 
      case report.
PG  - e4931
LID - 10.1097/MD.0000000000004931 [doi]
LID - e4931
AB  - INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway 
      obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is 
      useful for securing the fetal airway while maintaining fetal oxygenation via 
      placental circulation. Factors, including poor posture of the fetus and 
      physician, narrow visual field, and issues of contamination in the aseptic 
      surgical field, make fetal intubation during the EXIT procedure difficult. 
      Herein, we report our experience of the usefulness of the GlideScope video 
      laryngoscope (GVL) for intubation during the EXIT procedure. SYMPTOMS AND 
      CLINICAL FINDINGS: A 28-year-old woman presented with a fetus having a cystic 
      neck mass diagnosed on prenatal ultrasound at 25 weeks of gestation. We planned 
      the EXIT procedure in conjunction with cesarean delivery at 38 weeks of 
      gestation, as the mass enlarged to 4.9 cm x 3.2 cm, protruded externally at the 
      neck, and subsequently resulted in polyhydramnios. THERAPEUTIC INTERVENTION AND 
      OUTCOMES: After induction of anesthesia using intravenous thiopental (300 mg), 
      adequate uterine relaxation was achieved with sevoflurane (2.0-3.0 vol%) combined 
      with continuous intravenous infusion of nitroglycerin (0.5-1.0 mug/kg/min) for 
      maintaining uteroplacental circulation. After hysterotomy, the head and right 
      upper limb of the fetus were partially delivered, and fetal heart tones were 
      monitored with a sterile Doppler probe. After oropharyngeal suctioning to improve 
      the visual field, the fetus was intubated successfully using a sterile GVL by an 
      anesthesiologist, and the passage of the endotracheal tube beyond the vocal cords 
      was confirmed on the screen of the GVL system. Immediately after the fetal airway 
      was definitely secured, the fetus was fully delivered with umbilical cord 
      clamping. After delivery, nitroglycerine administration was ceased and 
      sevoflurane administration was reduced to 0.5 minimum alveolar concentration. 
      Additionally, oxytocin (10 units) and carbetocin (100 mug) were administered for 
      recovery of uterine contraction. Cesarean delivery was successfully performed 
      without any problems, and the neonate successfully underwent surgery for removal 
      of the neck mass under general anesthesia on the 7th day after delivery. The 
      neonate is developing normally. CONCLUSION: The GVL approach may be a useful 
      noninvasive approach for establishing a clear fetal airway during the EXIT 
      procedure.
FAU - Byun, Sung Hye
AU  - Byun SH
AD  - aDepartment of Anesthesiology and Pain Medicine bDepartment of Obstetrics and 
      Gynecology, School of Medicine, Catholic University of Daegu, Daegu, Republic of 
      Korea.
FAU - Lee, So Young
AU  - Lee SY
FAU - Hong, Seong Yeon
AU  - Hong SY
FAU - Ryu, Taeha
AU  - Ryu T
FAU - Kim, Baek Jin
AU  - Kim BJ
FAU - Jung, Jin Yong
AU  - Jung JY
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - IM
MH  - Adult
MH  - Branchioma/embryology/*surgery
MH  - Female
MH  - Fetoscopy/*instrumentation/methods
MH  - Fetus/surgery
MH  - Head and Neck Neoplasms/embryology/*surgery
MH  - Humans
MH  - Intubation, Intratracheal/*instrumentation/methods
MH  - *Laryngoscopes
MH  - Laryngoscopy/*instrumentation/methods
MH  - Pregnancy
MH  - Prenatal Diagnosis
PMC - PMC5265926
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2016/09/30 06:00
MHDA- 2017/02/18 06:00
PMCR- 2016/09/30
CRDT- 2016/09/30 06:00
PHST- 2016/09/30 06:00 [entrez]
PHST- 2016/09/30 06:00 [pubmed]
PHST- 2017/02/18 06:00 [medline]
PHST- 2016/09/30 00:00 [pmc-release]
AID - 00005792-201609270-00043 [pii]
AID - 10.1097/MD.0000000000004931 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2016 Sep;95(39):e4931. doi: 10.1097/MD.0000000000004931.