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Neuraxial block for EXIT procedure (ex utero intrapartum treatment) - A case report and literature review

Introduction: The ex utero intrapartum treatment (EXIT) involves the partial removal of the fetus from the uterine cavity during a cesarean section while maintaining placental circulation and oxygenation. This procedure is indicated when we expect a difficult access to the respiratory airway. Clinical Case: A 33-year-old female patient, with 35.4 weeks of pregnancy and a diagnosis of placenta accreta and a fetus with Bochdaleck’s diaphragmatic hernia diagnosed by prenatal ultrasound, was scheduled for elective cesarean with the EXIT procedure. The chosen anesthetic technique for the patient was neuraxial anesthesia. Conclusion: The EXIT procedure is a challenge for the anesthesiologist, and they should be aware and prepared for the physiological changes of pregnancy and uteroplacental physiology. This case demonstrates that even though the preferred technique in the EXIT procedure is general anesthesia, it can also be performed effectively and safely under a neuraxial technique with invasive monitoring.