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Fetal Surgery and the EXIT Procedure

Anesthesia Implications

Clinically reviewed by anesthesia providers · Updated

Position : Supine, left uterine displacement, arms extended
Time : 1-2 hours (average)
Blood Loss : Very High (500+ ml)
Post-op Pain : Moderate (4-6)
Maintenance Paralytic : Yes
Considerations : Arterial line, Aspiration risk / Full stomach, High Blood Loss, Neonatal resuscitation / NICU standby, Pregnancy / Obstetric

Anesthetic Approaches

1GETT, Epidural
2GETT, Remifentanil Drip, Propofol Drip
3Epidural
The Surgery

Placental mapping - intraoperative ultrasound locates the placenta before any incision, since the hysterotomy has to clear its edge. Severe polyhydramnios is drained first so the edge is not hidden....

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