• Osamu Tajiri, Takeshi Tateda, Haruhisa Sugihara, Hideo Yokoyama, Osamu Nishikido, and Chisako Mukumoto.
• Department of Anesthesiology, St. Marianna University School of Medicine, Kawasaki 216-8511.
• Masui. 2004 Apr 1; 53 (4): 407-10.

AbstractA 64-year-old woman underwent open-heart surgery for repair of atrial septal defect (ASD) and tricuspid valve regurgitation. Preoperative complications included rheumatoid arthritis with pain in both wrists treated with methotrexate. Following smooth endotrachial intubation, a pulmonary arterial (PA) catheter was inserted into the right jugular vein after several attempts. She was placed in a supine position with abduction of the shoulders to approximately 90 degrees and of the elbows to 60 degrees. Operation was performed through sternum splitting to second intercostal space, and the 4-h intraoperative course was uneventful. On the first postoperative day, she complained of inability to raise her right arm. Neurological examination revealed marked weakness of the deltoid and biceps brachialis muscles, and decreased sensitivity around the right shoulder. Iatrogenic brachial plexus injury was diagnosed. Administration of vitamin B12 and physical therapy were instituted. Symptoms improved gradually and had disappeared by 3 months postoperatively. Neuropathy might be attributed to stretch and compression of the brachial plexus caused by traction of the pectoralis minor muscle enhanced by sternotomy and/or malposition of the upper extremity, or direct injury due to cannulation of the PA catheter into the internal jugular vein.

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