[Postoperative paralysis of the bronchial plexus due to positioning]

A survey of the literature on problems of postoperative Duchenne-Erb paralyses caused by particular forms of arm positioning is followed by a report on observations made by the authors on a total of eleven patients. The paralyses observed were above all those of muscles of the Duchenne-Erb group. In four cases there were observed musculocutaneous paralyses. The tendency for reinnervation was good to excellent. Responsible for the development of paralysis was, in eight cases, the unphysiologic positioning of the arm during anesthesia and, as an additional straining moment, either the pressing down of the shoulders for Trendelenburg's position of the retroflection of the head in operations for struma. In three cases there was observed an involvement of that arm which had to be subjected to hyperabduction for the purpose of insuring free access to the site of operation. The careful analysis of causes requires important prophylactic considerations to be made. Also, consideration should be given to consequences in connection with insurance law, since the development of paralyses is in direct contradistinction to the risk involved in a surgical operation.