Lorentz A, Podstawski H, Osswald P M
Institut für Anaesthesiologie und Reanimation, Fakultät für klinische Medizin Mannheim, Universität Heidelberg.
Anaesthesist. 1988 Jun;37(6):381-3.
Injuries to nerves of the head occur infrequently following general anesthesia. Lesions of the facial and mental nerves have been reported.
A healthy 40-year-old woman was scheduled for derotation osteotomy of the left femur. The previous medical history included ten uneventful general anesthetics mainly for abdominal and orthopedic surgery. Routine preoperative investigations were unremarkable. The patient received midazolam for premedication. Induction of anesthesia was carried out with thiopental and succinylcholine. Ventilation with the anesthesia mask was difficult, and considerable pressure was exerted on the mask. Intubation of the trachea was accomplished on the second attempt after additional doses of thiopental and succinylcholine and intermittent manual ventilation by mask, which lasted for 5-6 min. The further course of anesthesia was uneventful. The surgical procedure lasted for 1 1/2 h. On the 1st day after anesthesia the patient noticed numbness of the lower lip. Perception of temperature and touch was impaired. The area of paresthesia/anesthesia corresponded to the area of innervation of the upper branches of the mental nerves. Complete remission occurred within 6 weeks.
Injury to nerves of the head due to pressure applied during anesthesia is infrequent. Lesions of branches of the facial nerve--mainly the marginal mandibular branch--have been reported. We found only two case reports of injury to the mental nerve in the literature. In general, long lasting anesthesia delivered via face mask preceded the injury. It was frequently difficult to retain airway patency.(ABSTRACT TRUNCATED AT 250 WORDS)
全身麻醉后头部神经损伤很少见。已有面神经和颏神经损伤的报道。
一名40岁健康女性计划行左股骨旋转截骨术。既往病史包括10次主要用于腹部和骨科手术的平稳全身麻醉。术前常规检查无异常。患者术前用咪达唑仑进行预处理。用硫喷妥钠和琥珀酰胆碱诱导麻醉。用麻醉面罩通气困难，对面罩施加了相当大的压力。在追加硫喷妥钠和琥珀酰胆碱剂量并通过面罩进行间歇性手动通气（持续5 - 6分钟）后，第二次尝试成功完成气管插管。麻醉的后续过程平稳。手术持续了1个半小时。麻醉后第1天患者注意到下唇麻木。温度和触觉感知受损。感觉异常/麻醉区域与颏神经上支的支配区域相对应。6周内完全缓解。
麻醉期间因施加压力导致头部神经损伤很少见。已有面神经分支——主要是下颌缘支——损伤的报道。我们在文献中仅发现两例颏神经损伤的病例报告。一般来说，损伤之前常有通过面罩进行的长时间麻醉。保持气道通畅常常很困难。（摘要截短至250字）
