Safety of Neck Rotation for Ear Surgery in Children With Down Syndrome

Objective Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery. Study Design Prospective consecutive patients, each serving as his or her own control. Methods Somatosensory evoked potentials were recorded from 17 children who were undergoing elective o...

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Bibliographic Details
Published in:The Laryngoscope 2000-09, Vol.110 (9), p.1442-1445
Main Authors: Wendell Todd, N., Holt, Philip J., Thomas Allen, A.
Format: Article
Language:English
Subjects:
Adolescent
Atlanto-Axial Joint - physiology
atlanto-occipital joint
Atlanto-Occipital Joint - physiology
Atlantoaxial joint
Biological and medical sciences
Child
Child, Preschool
Complex syndromes
Down Syndrome
Ear - surgery
Elective Surgical Procedures
Evoked Potentials, Somatosensory - physiology
Female
Humans
Infant
Intraoperative Complications - prevention & control
joint instability
Male
Medical genetics
Medical sciences
Non tumoral diseases
odontoid process
Odontoid Process - physiology
Otorhinolaryngologic Surgical Procedures - methods
Otorhinolaryngology (head neck, general aspects and miscellaneous)
Otorhinolaryngology. Stomatology
Posture
Prospective Studies
Radiography
somatosensory evoked potentials
spinal cord compression
Spinal Cord Compression - diagnostic imaging
Spinal Cord Compression - prevention & control
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Summary:Objective Seek information about spinal cord safety for children with Down syndrome positioned for ear surgery. Study Design Prospective consecutive patients, each serving as his or her own control. Methods Somatosensory evoked potentials were recorded from 17 children who were undergoing elective otolaryngological surgery. None of the patients had neurological symptoms or physical examination findings suggesting cervical spinal cord embarrassment. Specifically, muscle tone was normal or mildly reduced globally, consistent with Down syndrome, and deep tendon reflexes were normal and not appreciably different in the upper and lower extremities. On plain lateral radiographs obtained in the neutral, flexed, and extended positions, the patients' cervical spines were normal. Results When the anesthetized children had their necks placed in either right or left 60° rotation, no significant change in somatosensory latency or amplitude was found. With more than 99.999% certainty, neurologically intact children with Down syndrome with normal plain cervical spine radiographs were not exposed to extra risks by 60° neck rotation during surgery. Conclusion Patients with Down syndrome who are neurologically intact and who have normal lateral neck radiographs do not appear at great risk with neck rotation.
ISSN:0023-852X
1531-4995
DOI:10.1097/00005537-200009000-00005