How much neck extension would you require?

BACKGROUND

Neck extension in an anaesthetised patient aids many head and neck surgical procedures and is traditionally achieved with a shoulder bolster. Unfortunately, once the patient is draped, any adjustment to extension involves lifting the patient to reposition the bolster, which is cumbersome and time consuming.

TECHNIQUE

An innovative way of adjusting neck extension is with a pressure infuser bag placed under the shoulder as part of initial patient positioning. The bag is then inflated using the attached handheld pump, which extends the neck to the required degree (Fig 1). Placing a padded sheet over the bag (eg an incontinence pad) is advised to reduce risk of fragile skin damage, particularly if greater inflation is required and for longer procedures.

Figure 1.

Bag inflated using pump to provide required neck extension

Perioperatively, the degree of neck extension can be altered with minimum disruption by using the handheld pump to adjust the amount of inflation. We recommend that a periodic assessment of inflation is carried out, especially during longer procedures, as it is acknowledged that infuser bags can leak. At the end of the procedure, the bag can be completely deflated to aid wound closure.

DISCUSSION

Using a pressure infuser bag to provide neck extension has been described previously in the context of intubating patients with difficult airways.¹ We have applied this technique to operative procedures of the neck, particularly thyroid and parathyroid surgery, and found that this innovative application is excellent at providing and adjusting neck extension with minimal patient manual handling and operative disruption.