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Sternotomy and the Beard
HOW-TO-DO-IT
How-To-Do-It
Sternotomy and the Beard Lucas H.A. Sanders, MD, FRACS a,∗ , F. Joost ter Woorst, MD a , Auke Dick van der Meer, MD b , Dorinda J. Giebelen b and William M. Weightman, MD, FANZCA c a
Department of Cardiathoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands b Department of Anesthesia, Catharina Hospital, Eindhoven, The Netherlands c Department of Anesthesia, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
The presence of a beard or lower facial hair can pose a problem during skin preparation, cervical venous line insertion and draping of a patient for a sternotomy. We demonstrate how this can be dealt within a simple and economic fashion. (Heart, Lung and Circulation 2008;17:139–140) © 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Sternotomy; Beard
Figure 1. Bearded patient.
Figure 2. Easy access for sternotomy.
Method
T
he presence of a beard can pose several problems during anaesthesia and preparation for a sternotomy. Previous reports have demonstrated difficulty with mask ventilation1,2 and how this can be dealt with.3,4 During cervical central venous catheterisation and for a sternotomy, a beard can interfere with the skin preparation and sterility of the procedure (Fig. 1). Additionally the disinfectant solution can temporarily discolour the beard. These problems can be solved by retracting the beard or shaving it off. The reasons for having a beard are various. Requiring the beard to be shaven off can have cosmetic, status, Received 6 September 2007; accepted 6 September 2007; available online 3 December 2007 ∗ Corresponding author at: Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelo laan 2, 5623EJ Eindhoven, The Netherlands. Tel.: +31 4 2398680; fax: +31 4 2440268. E-mail address: [email protected] (L.H.A. Sanders).
Figure 3. Easy access for central venous line insertion.
© 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
1443-9506/04/$30.00 doi:10.1016/j.hlc.2007.09.005
140 HOW-TO-DO-IT
Sanders et al. Sternotomy and the Beard
employment, social or religious consequences and raise justified objections from the patient. Our method of dealing with the beard involves positioning of the beard in an anterior and cranial direction over the mandible. This is performed after the patient has been induced and intubated. The beard is then maintained in this position by applying a surgical face mask in its normal position (Fig. 2). Subsequently central venous line insertion, skin preparation for a sternotomy and draping can occur without hindrance of the beard (Fig. 3).
Heart, Lung and Circulation 2008;17:139–140
References 1. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth 2005;19(1):7–11. 2. Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, Ludwig TA. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 2006;105(5):885–91. 3. Boyce JR. Poor man’s LMA: achieving adequate ventilation with a poor mask seal. Can J Anaesth 2001;48(5):483–5. 4. Jaeger K, Ruschulte H, Heine J. Management of the beard problem. Resuscitation 2000;45(2):146–7.
How-To-Do-It
Sternotomy and the Beard Lucas H.A. Sanders, MD, FRACS a,∗ , F. Joost ter Woorst, MD a , Auke Dick van der Meer, MD b , Dorinda J. Giebelen b and William M. Weightman, MD, FANZCA c a
Department of Cardiathoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands b Department of Anesthesia, Catharina Hospital, Eindhoven, The Netherlands c Department of Anesthesia, Sir Charles Gairdner Hospital, Nedlands, Perth, Australia
The presence of a beard or lower facial hair can pose a problem during skin preparation, cervical venous line insertion and draping of a patient for a sternotomy. We demonstrate how this can be dealt within a simple and economic fashion. (Heart, Lung and Circulation 2008;17:139–140) © 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved. Keywords. Sternotomy; Beard
Figure 1. Bearded patient.
Figure 2. Easy access for sternotomy.
Method
T
he presence of a beard can pose several problems during anaesthesia and preparation for a sternotomy. Previous reports have demonstrated difficulty with mask ventilation1,2 and how this can be dealt with.3,4 During cervical central venous catheterisation and for a sternotomy, a beard can interfere with the skin preparation and sterility of the procedure (Fig. 1). Additionally the disinfectant solution can temporarily discolour the beard. These problems can be solved by retracting the beard or shaving it off. The reasons for having a beard are various. Requiring the beard to be shaven off can have cosmetic, status, Received 6 September 2007; accepted 6 September 2007; available online 3 December 2007 ∗ Corresponding author at: Department of Cardiothoracic Surgery, Catharina Hospital, Michelangelo laan 2, 5623EJ Eindhoven, The Netherlands. Tel.: +31 4 2398680; fax: +31 4 2440268. E-mail address: [email protected] (L.H.A. Sanders).
Figure 3. Easy access for central venous line insertion.
© 2007 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Inc. All rights reserved.
1443-9506/04/$30.00 doi:10.1016/j.hlc.2007.09.005
140 HOW-TO-DO-IT
Sanders et al. Sternotomy and the Beard
employment, social or religious consequences and raise justified objections from the patient. Our method of dealing with the beard involves positioning of the beard in an anterior and cranial direction over the mandible. This is performed after the patient has been induced and intubated. The beard is then maintained in this position by applying a surgical face mask in its normal position (Fig. 2). Subsequently central venous line insertion, skin preparation for a sternotomy and draping can occur without hindrance of the beard (Fig. 3).
Heart, Lung and Circulation 2008;17:139–140
References 1. Yildiz TS, Solak M, Toker K. The incidence and risk factors of difficult mask ventilation. J Anesth 2005;19(1):7–11. 2. Kheterpal S, Han R, Tremper KK, Shanks A, Tait AR, O’Reilly M, Ludwig TA. Incidence and predictors of difficult and impossible mask ventilation. Anesthesiology 2006;105(5):885–91. 3. Boyce JR. Poor man’s LMA: achieving adequate ventilation with a poor mask seal. Can J Anaesth 2001;48(5):483–5. 4. Jaeger K, Ruschulte H, Heine J. Management of the beard problem. Resuscitation 2000;45(2):146–7.