What’s going on in there?

 

By Laura Cavallone, MD, MSCI

Associate Professor and Vice Chair for Research of the Department of Anesthesiology at the University of Mississippi Medical Center, Jackson, Mississippi, USA

 

 

Figure 1

 

 

Figure 2

 

Questions

  1. What do these two pictures have in common and what do they have to do with Head and Neck surgery?
     

    Answer: ... Answers available for SHANA members

  2. What do you think is the cause of the injuries in Figure 1?
     

    Answer: ... Answers available for SHANA members

  3. How do these types of injury (Figure 1) occur?
     

    Answer: ... Answers available for SHANA members

  4. What do you think is the cause of the injury in Figure 2?
     

    Answer: ... Answers available for SHANA members

 

Take home message


In long, involved cases, when areas of the body are covered by drapes and/or wrapped in protective foam and cannot be regularly inspected (as is often the case in head and neck surgeries with the bed turned 180 degrees), the risk exists of serious injuries occurring with different mechanisms. Such injuries may go unnoticed until the end of the case, with critical consequences adding to the risks strictly related to the surgeries that these patients are undergoing. Positioning of the patient with head “away from the anesthesia location” and with arms tucked along the body, frequently occurs in major head and neck surgery, and the associated risks need to be recognized. Other potential injuries in this category include injuries due to mechanical compression (including nerve injuries) and ischemic injuries to the hand (or more specifically to the fingers receiving vascular supply from radial artery) when an arterial line (A-line) is in place. To prevent some of these injuries it may be advisable to consider foot lines (foot IV lines and dorsalis pedis A-line) in order to improve the possibility to monitor line sites intraopertively form the anesthesia location. To prevent finger ischemia in the territory supplied by the radial artery, when radial A-line is in place, consideration should be given to positioning a pulse-oxymetry probe on the index finger on the side of the radial A-line.

 

References
 

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