A6-MONTH-OLD infant, weighing 5.5 kg, was scheduled for resection of an occipital encephalocele. The patient was placed supine with his body on stacked blankets, his formed skull supported by a gel-padded Integra Mayfield horseshoe headrest with the encephalocele hanging freely beneath (fig. A). Mask induction maintaining spontaneous ventilation was coupled with direct laryngoscopy using a Miller 1 blade. With a grade 1 view, a 3.0-mm endotracheal tube was placed orally. The patient was then positioned prone for the procedure with the head resting in the headrest (fig. B). On completion of the surgery, the patients trachea was extubated in the operating room.
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