Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + At a Glance Download Section PDF Listen ++ 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 present. + Synonym Download Section PDF Listen ++ Sandifer Complex. + Incidence Download Section PDF Listen ++ Incidence is unknown, although there is some suggestion that it occurs in less than 1% of children with gastroesophageal reflux. + Clinical Aspects Download Section PDF Listen ++ 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. + Anesthetic Considerations Download Section PDF Listen ++ 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. + References Download Section PDF Listen ++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.