Anaesthesia for orthognathic surgery

摘要

Anaesthesia for orthognathic surgery requires thorough preoperative planning and multidisciplinary involvement. Patients are generally young and healthy, though there is an increasing trend in treatment of patients with obstructive sleep apnoea syndrome, associated with increased premorbid disease burden. Principles of perioperative management include close cooperation between surgeon and anaesthetist, a multifaceted approach to minimizing blood loss, multimodal analgesia, anti-emesis prophylaxis, and a carefully planned, communicated and executed airway management strategy. Nasotracheal intubation is routinely performed to maximize surgical access and permit intraoperative dental occlusion, though retromolar or submental intubation may occasionally be indicated. Patients with temporomandibular joint pathology or some congenital syndromes may necessitate awake airway management techniques. A clear strategy for tracheal extubation should be established in advance, including a well-defined re-intubation plan, especially for patients with intermaxillary fixation devices. Patients should be managed in an appropriately equipped and staffed postoperative care facility. ? 2023