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Head Extension (head + extension)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2004
S. Schulz-Stübner
Background:, Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient. Methods:, A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks. Conclusion:, Pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. Pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present. [source]

Effects of head posture on the oral, pharyngeal and laryngeal axis alignment in infants and young children by magnetic resonance imaging

PEDIATRIC ANESTHESIA, Issue 6 2008
RENAUD VIALET MD
Summary Background:, Objective anatomical studies supporting the different recommendations for laryngoscopy in infants and young children are scarce. The objective of this study was to measure by magnetic resonance imaging (MRI) the consequences of head extension on the oral, pharyngeal and laryngeal axes in infants and young children. Methods:, Thirty patients (age: 33 ± 28 months; weight 14 ± 9 kg), under general inhalated anesthesia delivered via a laryngeal mask airway, were studied in two anatomic positions: head in the resting position and in simple extension. The following measurements were made on each scan: the face and the neck axes, the pharyngeal axis, the laryngeal axis, and the line of vision of glottis. The various angles between these axes were defined: , angle between line of vision and laryngeal axis, and , angle between pharyngeal axis and laryngeal axis. From an anatomical point of view, laryngoscopy and passage of a naso-tracheal tube would be facilitated if these angles are narrow. Results:, Placing the patient from the resting position into extension led to a narrowing of the angle , but a widening of the angle ,. Conclusions:, In infants and young children, under general anesthesia and with a laryngeal mask airway in place, just a slight head extension improves alignment of the line of vision of the glottis and the laryngeal axis (narrowing of angle ,) but worsened the alignment of the pharyngeal and laryngeal axes (widening of angle ,). [source]

Laryngoscopy force in the sniffing position compared to the extension-extension position

ANAESTHESIA, Issue 4 2008
L. Lee
Summary Laryngoscopy is sometimes easier with the patient's head and neck in the extension-extension position (head extension with the neck extended by the head section of the table bent down at 30°) rather than the classical ,sniffing the morning air' position. We therefore tested the hypothesis that the axial force required for laryngoscopy is less in the extension-extension than the sniffing position. We measured the force axial to the handle of a Macintosh 3 laryngoscope in 20 subjects under general anaesthesia who had been given neuromuscular blocking drugs. Measurement of force was made in the sniffing position and the extension-extension position. The mean (SD) axial force required in the extension-extension position was lower than in the sniffing position (19.6 (7.8) N versus 23.6 (8.6) N, p = 0.04). In the setting of routine tracheal intubation, less force is required when the patient is in the extension-extension position than in the sniffing position. [source]