Anesth Analg 2006;102:1298-1299
© 2006 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000190767.00454.20
LETTER TO THE EDITOR
Prone View® with Mayfield Head Frames
David M. Bandola, MD, DMD, and
Shailendra Joshi, MD
Department of Anesthesiology, Milstein Hospital, New York, NY, sj121{at}columbia.edu
To the Editor:
High cervical surgery requires careful observation and evaluation of the patient's neuromuscular functions to ensure adequate monitoring of somatosensory and motor-evoked potentials. It can be very difficult to assess neuromuscular twitches because of limited access to the patient. One convenient site for monitoring neuromuscular blockade is the face. However, the prone position with head pinning makes it especially difficult to observe the facial twitches. We have found that the base plate of the Prone View® (Dupaco Inc., Oceanside, CA) can be utilized in this situation to view the face by obliquely placing it in the Mayfield head frame (Figure 1). There is usually adequate space (approximately 10–16 inches) between the head frame and the face to place the Prone View® mirror. This enables the anesthesiologist to monitor facial twitches without stooping beneath the table and losing sight of the operative field (Figure 2). This set-up also enables the detection of any facial contact with the components of the Mayfield frame. The mirror is not secured to the frame and therefore has to be monitored throughout the case. If used in this way, we recommend that the clamp handle of the Mayfield frame be secured with tape so that the mirror does not inadvertently release the frame. A flashlight for illumination can employed to increase face visualization when the room lights are dimmed for use of the operating microscope.
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Figure 2. The anesthesiologist is able to observe the facial twitches after stimulation of the facial nerve using the base plate of the prone without the need for bending down.
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