Staff View: Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)

Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)

The objective of this case report is to highlight the use of maternal Target Controlled Infusion (TCI) of Remifentanil to provide immobilization and analgesia to the fetal during Ex utero Intrapartum (EXIT) procedure. A 37 weeks of gestation fetal was diagnosed with Congenital High Airway Obstruct...

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Main Authors:	Abdul Karim, Othman, Mohd Sayuti, Razali, Mohd Habibullah, Zakaria, Noraslawati, Razak, Ruwaida, Isa
Format:	Article
Language:	English
Published:	2019
Subjects:	R Medicine (General)
Online Access:	http://eprints.unisza.edu.my/6420/1/FH02-FP-19-29423.pdf http://eprints.unisza.edu.my/6420/
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id	my-unisza-ir.6420
record_format	eprints
spelling	my-unisza-ir.64202022-05-22T02:40:17Z http://eprints.unisza.edu.my/6420/ Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS) Abdul Karim, Othman Mohd Sayuti, Razali Mohd Habibullah, Zakaria Noraslawati, Razak Ruwaida, Isa R Medicine (General) The objective of this case report is to highlight the use of maternal Target Controlled Infusion (TCI) of Remifentanil to provide immobilization and analgesia to the fetal during Ex utero Intrapartum (EXIT) procedure. A 37 weeks of gestation fetal was diagnosed with Congenital High Airway Obstruction Syndrome (CHAOS). EXIT procedure was preferred as the most favourable approach of management. With the concurrent use of general anaesthesia, TCI Remifentanil was infused to the mother with the aim to provide fetal immobilization and analgesia during surgical tracheostomy on the fetal. Tracheostomy was successfully done with excellent fetal immobilization without the requirement of other medications or muscle relaxant administered to the fetal circulation. In performing a delicate fetal airway surgery, the anaesthesiologist must achieve loss of consciousness, adequate analgesia and more importantly immobility to the fetal with a significant uterine relaxation while safely anaesthetizing the mother. There are several approaches of achieving fetal analgesia and immobility during EXIT procedure. These include the direct administration of anaesthetic drugs to the fetal blood circulation via intravenous or intramuscular route, intra-amniotic delivery or delivery of the anaesthetic drugs directly through maternal blood circulation in addition to inhalational anaesthetic agents. In our case, fetal analgesia and immobility was achieved through maternal blood circulation using TCI of Remifentanil and coupled with inhalational agent of sevoflurane. 2019-11 Article PeerReviewed text en http://eprints.unisza.edu.my/6420/1/FH02-FP-19-29423.pdf Abdul Karim, Othman and Mohd Sayuti, Razali and Mohd Habibullah, Zakaria and Noraslawati, Razak and Ruwaida, Isa (2019) Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS). Asian Journal of Medicine and Biomedicine, 3 (2). pp. 26-29. ISSN 2600-8173
institution	Universiti Sultan Zainal Abidin
building	UNISZA Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Sultan Zainal Abidin
content_source	UNISZA Institutional Repository
url_provider	https://eprints.unisza.edu.my/
language	English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Abdul Karim, Othman Mohd Sayuti, Razali Mohd Habibullah, Zakaria Noraslawati, Razak Ruwaida, Isa Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
description	The objective of this case report is to highlight the use of maternal Target Controlled Infusion (TCI) of Remifentanil to provide immobilization and analgesia to the fetal during Ex utero Intrapartum (EXIT) procedure. A 37 weeks of gestation fetal was diagnosed with Congenital High Airway Obstruction Syndrome (CHAOS). EXIT procedure was preferred as the most favourable approach of management. With the concurrent use of general anaesthesia, TCI Remifentanil was infused to the mother with the aim to provide fetal immobilization and analgesia during surgical tracheostomy on the fetal. Tracheostomy was successfully done with excellent fetal immobilization without the requirement of other medications or muscle relaxant administered to the fetal circulation. In performing a delicate fetal airway surgery, the anaesthesiologist must achieve loss of consciousness, adequate analgesia and more importantly immobility to the fetal with a significant uterine relaxation while safely anaesthetizing the mother. There are several approaches of achieving fetal analgesia and immobility during EXIT procedure. These include the direct administration of anaesthetic drugs to the fetal blood circulation via intravenous or intramuscular route, intra-amniotic delivery or delivery of the anaesthetic drugs directly through maternal blood circulation in addition to inhalational anaesthetic agents. In our case, fetal analgesia and immobility was achieved through maternal blood circulation using TCI of Remifentanil and coupled with inhalational agent of sevoflurane.
format	Article
author	Abdul Karim, Othman Mohd Sayuti, Razali Mohd Habibullah, Zakaria Noraslawati, Razak Ruwaida, Isa
author_facet	Abdul Karim, Othman Mohd Sayuti, Razali Mohd Habibullah, Zakaria Noraslawati, Razak Ruwaida, Isa
author_sort	Abdul Karim, Othman
title	Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
title_short	Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
title_full	Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
title_fullStr	Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
title_full_unstemmed	Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)
title_sort	target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for congenital high airway obstruction (chaos)
publishDate	2019
url	http://eprints.unisza.edu.my/6420/1/FH02-FP-19-29423.pdf http://eprints.unisza.edu.my/6420/
_version_	1734304563291226112
score	13.211869

Target controlled infusion of remifentanil for fetal analgesia and immobilization during the ex utero intrapartum treatment procedure for Congenital High Airway Obstruction (CHAOS)

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