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Positioning for the Nuss procedure: avoiding brachial plexus injury
Author(s) -
FOX MARY E.,
BENSARD DENIS D.,
BRENT ROATEN J.,
HENDRICKSON RICHARD J.
Publication year - 2005
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2005.01630.x
Subject(s) - medicine , pectus excavatum , nuss procedure , surgery , brachial plexus , brachial plexus injury , pneumothorax , palsy , thoracoscopy , sling (weapon) , forceps , anesthesia , alternative medicine , pathology
Summary Background: In 1987, Nuss developed a minimally invasive technique for the treatment of pectus excavatum. The procedure has had excellent results with minimal complications. Anesthetic concerns include risks of cardiothoracic injuries, dysrythmias, pneumothorax, pleural effusions, and hemorrhage. In addition, we identified a risk of brachial plexus injury that can occur secondary to patient positioning. We report our experience with the Nuss procedure and modified patient positioning. Methods: A retrospective chart review was performed on 95 children or adolescents who underwent a Nuss procedure at the Children's Hospital in Denver, CO, USA. The first group of patients (58) was positioned with their arms extended above their heads at a 90° angle at the shoulder. The second group of patients (37) was positioned in an arthroscopy sling in a neutral position utilizing a right angled suspension device attached to the operating room bed. Results: In the first group of patients, three of 58 (5.2%) children had transient brachial plexus injuries. To date, in the second group of patients, there have been no brachial plexus injuries using the suspension device. Conclusions: We found that patients are at risk of transient brachial plexus injury during the Nuss procedure due to positioning of the arms. A readily available device that permits the extremity to be maintained in a neutral position but also allows intraoperative manipulation during critical aspects of the Nuss procedure eliminates transient brachial plexus palsy.