Bette B, Martini M, Klaschik S, Hilbert T
Klinik und Poliklinik für Anästhesiologie und Spezielle Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
Abteilung für Mund‑, Kiefer- und Plastische Gesichtschirurgie, St. Lukas-Klinik, Solingen, Deutschland.
Anaesthesist. 2020 Sep;69(9):649-652. doi: 10.1007/s00101-020-00807-5. Epub 2020 Jun 26.
A 42-year-old female patient suffered an infranuclear hypoglossal nerve paresis with right-sided swelling and weakness of the tongue following a short duration mask anesthesia for a follicle puncture. This resulted in dysarthria and dysphagia persisting for more than 3 months. A return to work was initially impossible. Etiopathogenetically, a mechanical compression of the peripheral hypoglossal nerve by positioning or reclination during mask ventilation is discussed. Conclusion for clinical practice: In order to protect against lesions of the hypoglossal nerve, the pre-anaesthesiological examination should ask specifically about cervical problems as an indication of individual sensitivity to reclination. In such cases, special attention should be paid to careful patient positioning. Even shorter periods of reclination or compression of the soft tissues of the neck can result in lesions, therefore tolls such as a Wendl or Guedel tube should be used accordingly.
一名42岁女性患者在进行卵泡穿刺的短暂面罩麻醉后，出现核下性舌下神经麻痹，伴有右侧舌肿胀和无力。这导致构音障碍和吞咽困难持续超过3个月。起初无法重返工作岗位。从病因学角度讨论了面罩通气期间因体位或后仰导致外周舌下神经受到机械压迫的情况。临床实践结论：为防止舌下神经损伤，麻醉前检查应特别询问颈部问题，以此作为个体对后仰敏感性的指标。在这种情况下，应特别注意患者的体位摆放要小心。即使是较短时间的后仰或颈部软组织受压也可能导致损伤，因此应相应地使用诸如温德尔管或古德尔管等工具。
