Association of torsional dystonia, mainly involving
the neck and upper extremities, with either esophageal reflux or hiatus
hernia. During paroxysmal dystonic posture crisis, opisthotonos may be
Incidence is unknown, although there is some suggestion
that it occurs in less than 1% of children with gastroesophageal reflux.
Torsional dystonia occurs shortly after feeding
for 1 to 3 minutes (commonly mistaken for seizures). A relationship with
feeding may suggest a diagnosis of Sandifer syndrome.
No particular anesthetic consideration
is known, however the disorder should be known because of its possible confusion with
seizures. Rapid sequence induction is recommended for these patients because
of gastric reflux. Postoperative administration of antacid medication is useful.
Puntis JW, Smith HL, Buick RG, et al: Effect of dystonic movements on
oesophageal peristalsis in Sandifer's syndrome. Arch Dis Child 64(9):1311, 1989.