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The beach-chair position is very commonly employed for upper limb procedures. Safe stabilisation of the patient's head can be problematic when using this position because of the location of the airway and the need for securing the patient's head to the headboard.
A specific chin-strap is commercially available. This system has an aperture for the airway and Velcro straps for fastening; however, it only has one-point fixation, which regularly necessitates additional stabilisation with a crêpe bandage (Fig. 1). Furthermore, they individually cost £12.92. We estimate our annual cost to be more than £6400, based on ~500 procedures per year. The senior author (RHA) felt that this arrangement could be improved, and developed the idea of utilising the back-strap from the sling that the patient will be placed into at the end of the procedure. A 2-cm slit is cut longitudinally at the half-way point of the strap to allow passage of the airway, it is then passed through the buckles on either side of the headboard; finally, the ends of the strap attached to each other across the forehead with Velcro (Fig. 2).
Not only is this method more secure by providing two-point fixation, it is fully adjustable, it is quicker to apply and to release, and it remains usable as the back-strap at the end of the procedure if required and no extra cost has been incurred.