Anesthesia for Oral and Maxillofacial Surgery

Contents
Contributors
1: History of Oral and Maxillofacial Anesthesia
1.1 History of Oral Anesthesia
1.2 History of Oral Anesthesia in China
1.3 Anesthesia for Oral and Maxillofacial Surgery
1.4 Summary and Prospect
References
2: Oral and Maxillofacial Anatomy
2.1 Systematic Anatomy of Oral Cavity
2.1.1 The Bones
2.1.1.1 The Maxilla
2.1.1.2 The Mandible
2.1.1.3 The Palatine Bone
2.1.1.4 The Sphenoid Bone
2.1.1.5 The Temporal Bone
2.1.2 The Temporomandibular Joint
2.1.2.1 The Formation
2.1.2.2 The Movements
2.1.3 The Muscles
2.1.3.1 The Muscles of Facial Expression
2.1.3.2 The Masticatory Muscles
2.1.3.3 The Muscles of Neck
2.1.3.4 The Muscular Palate and Muscles of Pharynx
2.1.4 The Salivary Gland
2.1.4.1 The Parotid Glands
2.1.4.2 The Submandibular Glands
2.1.4.3 The Sublingual Glands
2.1.5 The Vessel
2.1.5.1 The Artery
The Common Carotid Artery
The External Carotid Artery
The Internal Carotid Artery
The Subclavian Artery
The Arterial Anastomosis in Head and Neck
2.1.5.2 The Veins
The Superficial Veins in the Oral and Maxillofacial Region
The Deep Vein of Oral and Maxillofacial Region
Superficial Jugular Veins
Deep Jugular Veins
2.1.6 The Lymph Node and Lymphatic Vessel
2.1.7 The Nerve
2.1.7.1 The Trigeminal Nerve
The Ophthalmic Nerve
The Maxillary Nerve
The Mandibular Nerve
2.1.7.2 The Facial Nerve
2.1.7.3 The Glossopharyngeal Nerve
2.1.7.4 The Vagus Nerve
2.1.7.5 The Hypoglossal Nerve
2.1.7.6 The Accessory Nerve
2.1.7.7 The Cervical Plexus and Cervical Sympathetic Trunk
The Cervical Plexus
The Cervical Sympathetic Trunk
2.2 The Regional Anatomy of the Oral Cavity
2.2.1 The Oral Cavity
2.2.1.1 The Realm and Distribution of Oral Cavity
Oral Vestibule
Oral Cavity Proper
2.2.1.2 The Lips
2.2.1.3 The Cheeks
2.2.1.4 The Teeth
2.2.1.5 The Gingiva
2.2.1.6 The Palate
The Hard Palate
The Soft Palate
2.2.1.7 The Pharynx
2.2.1.8 The Tongue
Tongue Morphology
The Periglottis
The Muscles
The Nerves and Blood Supply of the Tongue
2.2.2 The Parotideomasseteric Region and Deep Lateral Aspect of Face
2.2.2.1 The Parotideomasseteric Region
The Realm
The Layers
2.2.2.2 The Deep Lateral Aspect of Face
The Realm
The Position Relation
2.2.3 Oral Maxillofacial Loose Connective Tissue Interspace
2.2.3.1 The Infraorbital Space
The Buccal Cavity
The Masseteric Space
The Pterygomandibular Space
2.2.4 The Neck
2.2.4.1 The Border and Distribution
Triangles of the Neck
2.2.4.2 Body Surface Symbol
The Hyoid Bone
The Prominentia Laryngea
The Cricoid Cartilage
The Cervical Trachea
The Sternocleidomastoid Muscle
The Supraclavicular Fossa
The Suprasternal Fossa
2.2.4.3 The Cervical Fascia and Fascial Spaces
Superficial Cervical Fascia
Deep Cervical Fascia
The Investing Layer of Deep Cervical Fascia
Pretracheal Layer of Deep Cervical Fascia
The Prevertebral Layer of Deep Cervical Fascia
2.2.4.4 The Submandibular Triangle
The Borders
The Layers
The Contents
2.2.4.5 The Cervical Part of Trachea
2.2.4.6 The Carotid Triangle
The Arteries
The Veins
The Nerves
The Posterior Belly of Digastric Muscles
2.2.4.7 The Sternocleidomastoid Region
The Realm
The Layers
The Structures
2.2.4.8 The Posterior Neck Triangle
The Borders
The Layers
The Contents
References
3: Characteristics of Patients Undergoing Oral and Maxillofacial Surgery
3.1 Common Oral and Maxillofacial Diseases
3.1.1 Morbidity and Characteristics of Pediatric Patients
3.1.2 Morbidity and Characteristics of Elderly Patients
3.2 Common Syndromes in Oral and Maxillofacial Surgery
3.2.1 Common Syndromes in Oral and Maxillofacial Surgery
3.2.2 Syndromes with Abnormal Development of Internal Vital Organs
3.2.3 Syndromes Related to Upper Airway Obstruction
3.2.4 Syndromes Accompanied with Mental Retardation
3.2.5 Syndromes Involving Gingivodental Tissues
3.2.6 Syndromes Involving Branchial Arches
3.2.7 Syndromes Involving Orofacial Clefts
3.2.8 Syndromes with Unusual Faces
3.3 Systemic and Vital Viscera Complications
3.4 Combined Modality Therapy
3.4.1 Combined Modality Therapy for Oral and Maxillofacial Tumors
3.4.2 Combined Modality Therapy for Congenital Malformations
3.4.2.1 Cleft Lip and Palate
3.4.2.2 Congenital Craniofacial Malformation
3.5 Characteristics of Oral and Maxillofacial Injury Patients
3.5.1 Rich Blood Circulation in the Oral and Maxillofacial Region and Related Effects
3.5.2 The Influence of Teeth
3.5.3 Easy to Cause Complications Such as Craniocerebral and Neck Injury
3.5.4 Prone to Cause Asphyxia
3.5.5 Affecting Eating and Oral Hygiene
3.5.6 Wound Contamination
3.5.7 Facial Malformations
3.6 Preoperative Anesthesia Evaluation and Optimization
3.6.1 Preoperative Anesthesia Evaluation and Optimization of Patients Undergoing Oral and Maxillofacial Surgery
3.6.1.1 Assessment of the Patient’s General Condition
Medical History
Assessment of Physical Examination
Preoperative Tests
Complications
Evaluation and Optimization of the Cardiovascular System
Assessment and Optimization of Respiratory System
Assessment of Nervous System
Other Diseases
Evaluation of Mental Status
Paranesthesia Examinations and Tests
References
4: Medical Risk Management of Anesthesia for Oral and Maxillofacial Surgery
4.1 Introduction
4.2 Defining “Medical Malpractice”
4.3 Characteristics of Oral and Maxillofacial Surgery
4.4 Characteristics of Medical Malpractice in Oral and Maxillofacial Surgery
4.5 Accidents and Medical Malpractice
4.6 Causes and Their Analysis
4.6.1 Root Cause Analysis (RCA)
4.6.2 SHEL Model, SHELL Model, and P-mSHELL Model
4.6.3 4M4E
References
5: Recognition and Management of the Difficult Airway
5.1 Introduction
5.2 Normal Anatomy of the Airway
5.2.1 Nasal Cavity
5.2.2 Larynx
5.2.3 Trachea and Bronchi
5.3 Knowing About Difficult Airway
5.3.1 Definition of Difficult Airway
5.3.2 Characteristics of Difficult Airways in Oral and Maxillofacial Head and Neck Surgery
5.3.3 Difficult Airway Assessment
5.3.3.1 Difficult Mask Ventilation
5.3.3.2 Difficult Tracheal Intubation
Medical History
General Physical Examination
Special Examination
Difficulty in Backup Program
Difficulty in Laryngeal Mask Placement
Difficulty in Cricothyrotomy and Tracheotomy.
5.4 The Establishment of Difficult Airway
5.4.1 Establishment of the Airway Without Intubation
5.4.1.1 Mask Ventilation
5.4.1.2 Supraglottic Airway Device (SAD)
Laryngeal Mask Airway (LMA)
Intubating Laryngeal Mask
Laryngeal Tube (LT)
Others
5.4.2 Difficult Airway Intubation
5.4.2.1 Route of Intubation and Endotracheal Tube
5.4.2.2 Intubation Methods
Surgical Versus Non-surgical
Awake Versus Non-Awake
Pre-Anesthesia Visits
Pre-Anesthetic Medication
Benzodiazepines
Opioids
Anticholinergics
Vasoconstrictors of Nasal Mucosa
Personnel and Equipment
Personnel
Monitoring Equipment
Difficult Airway Cart
Airway Surface Anesthesia
5.4.3 Commonly Used Difficult Tracheal Intubation Methods
5.4.3.1 Tracheal Tube Guidance Device
Elastic Bougie
Fiber Optic Laryngoscopes
Fiberoptic Bronchoscope
Nasotracheal Intubation Using Fiberoptic Bronchoscope
Orotracheal Intubation Using Fiberoptic Bronchoscope
Light Wand and Blind Intubation Devices
Intubating Laryngeal Mask
5.4.3.2 Video Laryngoscope
Without Tracheal Tube Guided Access
With Tracheal Tube Guided Access
Retrograde Guided Intubation
5.4.4 Establishment of Surgical Airway
5.4.4.1 Cricothyroid Puncture and Incisional Ventilation
5.4.4.2 Percutaneous Dilatation Tracheotomy
5.4.5 Difficult Airway Establishment Process
5.4.5.1 Anticipated Difficult Airway
5.4.5.2 Unanticipated Difficult Airway
5.5 Tracheal Tube Fixation
5.6 Management of Postanesthesia Recovery
5.6.1 Extubation
5.6.2 Prophylactic Tracheotomy
References
6: General Anesthetic Techniques in Oral and Maxillofacial Surgery
6.1 Concepts and Methods of General Anesthesia
6.1.1 The Concept of General Anesthesia
6.1.2 What Is Ideal General Anesthesia?
6.1.2.1 Reduced Surgical Stimulation
6.1.2.2 Safety
6.1.3 Indications for Dental General Anesthesia
6.1.3.1 When Local Anesthetics Do Not Provide Adequate Analgesia and Safety
6.1.3.2 Pediatric, Disabled, and Dentophobic Patients Who Cannot Undergo Dental Procedures or Treatments Under Conscious Control
6.1.3.3 When Local Anesthetics Cannot Be Used
6.2 Pre-operative Evaluation
6.3 Induction
6.3.1 Rapid Induction
6.3.2 Slow Induction
6.3.3 Other Induction Methods
6.4 Intraoperative Management
6.4.1 Controlled Breathing
6.4.1.1 VCV
6.4.1.2 PVC
6.4.2 Special Airway Management Methods
6.4.2.1 Positive End-Expiratory Pressure (PEEP)
6.4.2.2 High-Frequency Ventilation (HFV)
6.4.2.3 Pulmonary Protection Ventilation
6.4.3 Humidification and Removal of Bacteria
6.4.4 Circulatory System Management
6.4.5 Other Management
6.4.5.1 Body Temperature
6.4.5.2 Urine Output
6.4.5.3 Acid-Base Balance
6.4.6 Special Management Methods
6.4.6.1 Controlled Hypotension
6.4.6.2 Low-Flow Anesthesia
6.5 Post-anesthesia Awakening
6.5.1 Discontinuation of Anesthetic Drugs
6.5.2 Intraoral and Intraairway Suctioning and Monitoring of Awakening Status
6.5.3 Extubation
6.6 Prevention and Management of Perioperative Complications
6.6.1 Respiratory Complications
6.6.1.1 Airway Obstruction
6.6.1.2 Laryngospasm
6.6.1.3 Bronchospasm
6.6.1.4 Pulmonary Edema
6.6.1.5 Pneumothorax
6.6.2 Circulatory Complications
6.6.2.1 Hypotension
6.6.2.2 Hypertension
6.6.2.3 Cardiac Arrhythmias
6.6.2.4 Acidosis
6.6.3 Other Complications
6.6.3.1 Anaphylaxis
6.6.3.2 Hypothermia
6.6.3.3 Peripheral Nerve Injury
6.6.3.4 Osteofascial Compartment Syndrome
6.6.3.5 Intraoperative Awareness
References
7: Local Anesthetic Techniques in Oral and Maxillofacial Surgery
7.1 Introduction
7.2 Common Local Anesthetics
7.2.1 Adverse Reactions of Local Anesthetics
7.3 Commonly Used Local Anesthesia Methods
7.3.1 Topical Anesthesia
7.3.2 Infiltration Anesthesia
7.3.2.1 Basic Operation
7.3.2.2 Indications
7.3.2.3 Precautions
7.3.2.4 Maxillary Buccal Infiltration Anesthesia
7.3.2.5 Palatal Infiltration Anesthesia
7.3.3 Nerve Block Anesthesia
7.3.3.1 Upper Alveolar Posterior Nerve Block Anesthesia (Tuberosity Injection)
7.3.3.2 Upper Alveolar Nerve Block Anesthesia
7.3.3.3 Upper Alveolar Anterior Nerve Block Anesthesia
7.3.3.4 Infraorbital Nerve Block Anesthesia
7.3.3.5 Palatal Major Nerve Block Anesthesia
7.3.3.6 Nasopalatal Nerve Block Anesthesia
7.3.3.7 Inferior Alveolar Nerve Block Anesthesia
7.3.3.8 Chin Nerve Block Anesthesia
7.3.4 Comparing Advantages and Disadvantages of Infiltration Anesthesia and Nerve Block (Table 7.2)
7.4 Conclusion
References
8: Conscious Sedation and Analgesia
8.1 The Concept of Sedation
8.1.1 Background
8.1.2 Classification
8.2 Sedation in Oral and Maxillofacial Surgery
8.2.1 The Purpose of Applying Sedation
8.2.2 Indications
8.2.3 Characteristics of Sedation in Oral and Maxillofacial Surgery
8.3 Types and Medication of Sedation
8.3.1 Types of Sedation
8.3.2 Other Methods
8.3.3 Medication
8.4 Inhalation Sedation
8.4.1 Characteristics of Nitrous Oxide and Its Application in Inhalation Sedation
8.4.2 Indications and Contraindications
8.4.3 Advantages and Disadvantages of Nitrous Oxide Inhalation Sedation
8.5 Intravenous Sedation
8.5.1 Medication
8.5.1.1 Benzodiazepines
Midazolam
Diazepam
8.5.1.2 Propofol
8.5.1.3 Dexmedetomidine
8.5.1.4 Antagonists
8.5.1.5 Other Drugs Used for Intravenous Sedation
Flurbiprofen Axetil
Ketamine
8.5.2 Assessment and Monitoring of Sedation Levels
8.5.2.1 Assessment of Sedation Levels with an Assessment Form
8.5.2.2 Objective Quantitative Evaluation of Sedation Level
8.6 Classification and Pathogenesis of Pain
8.6.1 Definition and Classification of Pain
8.6.1.1 Definition of Pain
8.6.1.2 Classification of Pain
Classification According to Etiology
Classification According to Pathophysiology
Classification According to Anatomical Location
8.6.2 Diagnosis of Pain
8.6.2.1 Medical History
General Information
Main Symptoms
History and Routine Medication
Family History of Diseases
Current Symptoms
8.6.2.2 Examination
Systemic Examination
Local Medical Examination (Maxillofacial and Oral Cavity)
Function and Disorders of the Cranial Nerves
8.7 Analgesia
8.7.1 Common Analgesics
8.7.1.1 Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Clinical Pharmacology
Commonly Used NSAIDs
8.7.1.2 Weak Opioids
Codeine
Buprenorphine
Tramadol
8.7.1.3 Strong Opioid Drugs
Clinical Pharmacology of Morphine
Use of Morphine
8.7.1.4 5-Hydroxytryptamines
8.7.1.5 Anti-epileptic Drugs
8.7.1.6 Antidepressants
8.7.1.7 Other Analgesics and Adjuvant Drugs
Local Anesthetics
α2 Adrenergic Agonists
Baclofen
Antiemetics
8.7.2 Nerve Block Therapy
8.7.2.1 Concept of Nerve Block
8.7.2.2 Mechanism of Nerve Block
Blocking the Nerve Conduction Pathway of Nociception
Block the Vicious Circle of Pain
Improve Blood Circulation
Anti-inflammatory Effect
8.7.2.3 Characteristics of Nerve Block Therapy
Reliable Analgesic Effect
Helping to Diagnose Diseases
Controllable
Small Side Effects
High Operation Technique Requirement
8.7.2.4 Indications and Contraindications of Nerve Block
Indications
Contraindications
8.7.2.5 Commonly Used Facial and Cervical Nerve Block Treatments
Trigeminal Ganglion Block
Linguopharyngeal Nerve Block
Stellate Ganglion Block
8.7.3 Treatment of Acute Pain
8.7.3.1 Treatment of Postoperative Pain
Route of Analgesic Administration
8.7.3.2 Patient-Controlled Analgesia
8.7.3.3 Regional Analgesic Techniques
8.7.3.4 Other Techniques
8.7.3.5 Preventive Analgesia
8.7.3.6 Perioperative Multimodal Analgesia
8.7.4 Treatment of Chronic Pain
8.7.4.1 Drug Treatment
8.7.4.2 Nerve Block
8.7.4.3 Trigger Point Injection
8.7.4.4 Physiotherapy
8.7.4.5 Spinal Cord Electrical Stimulation and an Intrathecal Morphine Pump
8.7.4.6 Psychological Treatment
8.7.4.7 Occupational Therapy
8.7.5 Cancer Pain Treatment
8.7.5.1 Treatment Principles of Cancer Pain
8.7.5.2 Treatment Methods
Etiological Treatment
Drug analgesic Treatment
8.8 Special Pains in Oral and Maxillofacial Area
8.8.1 Temporomandibular Disorders
8.8.1.1 Clinical Manifestations
8.8.1.2 Auxiliary Examinations
8.8.1.3 Diagnosis and Differential Diagnosis
Painful Disorders
Joint Disease
8.8.1.4 Treatment Principle
Treatment of the Cause
Conservative Treatment
Temporomandibular Joint Cavity Injection Treatment
Psychological and Cognitive-Behavioral Therapy
Surgical Treatment
Extracorporeal Shockwave Therapy
8.8.2 Burning Mouth Syndrome
8.8.2.1 Clinical Manifestations
8.8.2.2 Physical Examination
8.8.2.3 Auxiliary Examinations
8.8.2.4 Diagnosis and Differential Diagnosis
8.8.2.5 Treatment Principle
References
9: Complications Associated with Anesthesia: In Oral and Maxillofacial Surgery
9.1 Introduction
9.2 Complications Associated with Local Anesthesia in Oral and Maxillofacial Surgery
9.2.1 Classification and Chemical Structure of Local Anesthetics
9.2.2 Systemic Reactions Due to Local Anesthesia
9.2.2.1 Psychogenic Reactions
9.2.2.2 Systemic Toxicity
9.2.2.3 Allergy
9.2.2.4 Methemoglobinemia
9.2.3 Local Complications Associated with Local Anesthesia
9.2.3.1 Pain on Injection
9.2.3.2 Prolongation of Anesthesia and Various Sensory Disorders
9.2.3.3 No Effect
9.2.3.4 Trismus
9.2.3.5 Infection
9.2.3.6 Edema
9.2.3.7 Hematoma
9.2.3.8 Gingival Lesions
9.2.3.9 Soft Tissue Injury
9.2.3.10 Ophthalmologic Complications
9.2.4 Conclusion
9.3 Common Complications After General Anesthesia in Oral and Maxillofacial Surgery
9.3.1 Etiology of Dental Injury During Anesthesia
9.3.2 Oropharyngeal Airways
9.3.3 Predisposing Factors and Anesthetic Related Dental Injury
9.3.3.1 Localized Infection and Inflammation
9.3.3.2 Systemic Diseases with Intraoral Manifestations
9.3.4 Medication and Dental Disease
9.3.4.1 Age
9.3.4.2 Abnormal Oral and Maxillofacial Anatomy
9.3.4.3 Prosthetic Dental Restorations
9.3.5 Classification of Dental Injury
9.3.6 Prevention of Anesthetic Related Dental Injury
9.3.7 Protective Mouth Guards
9.3.7.1 Immediate Management of a Damaged Tooth During Anesthesia
9.3.8 Oral Soft Tissue Injuries
9.3.8.1 Injuries Associated with Throat Packs
9.3.8.2 Injuries Associated with Nasal Intubation
9.3.8.3 Epistaxis
9.3.8.4 Structural Injuries Associated with Nasotracheal Intubation
9.3.8.5 Eye Injuries During Oral and Maxillofacial Surgery
9.3.9 Conclusion
References
10: Anesthesia for Outpatient Oral and Maxillofacial Surgery
10.1 Introduction
10.2 Pre-anesthetic Preparation
10.2.1 Equipment and Operation Site
10.2.2 Anesthetics and Emergency Drugs
10.2.3 Pre-anesthetic Visit
10.3 Outpatient General Anesthesia
10.4 Local Anesthesia
10.5 Sedation and Analgesia
10.6 Monitored Anesthesia Care (MAC)
10.7 Risks of Anesthesia in the Oral and Maxillofacial Surgery Setting
10.8 Post-anesthetic Recovery and Discharge
10.8.1 Post-anesthetic Recovery
10.8.2 Discharge Instructions
10.9 Complications of Anesthesia in the Outpatient Oral and Maxillofacial Surgery
References
11: Anesthesia for Oral and Maxillofacial Plastic Surgery
11.1 Introduction
11.2 Preoperative Assessment and Preparation
11.2.1 Preoperative Assessment
11.2.2 Preoperative Preparation
11.3 Selection of Anesthesia Methods
11.3.1 The Mental State and Willingness of Patients
11.3.2 Age of Patients
11.3.3 Requirements of Surgical Operation
11.3.4 Surgical Site
11.3.5 Surgical Wound
11.4 General Anesthesia
11.4.1 Anesthesia Induction
11.4.2 Anesthesia Maintenance and Management
11.4.3 Management of Anesthesia Recovery Period
11.5 Sedation and Analgesia
11.5.1 Medication
11.5.2 Monitoring and Care During Sedation and Analgesia and Post-anesthesia
11.5.3 Common Complications and Their Management
11.6 Local Anesthesia
11.6.1 Types of Local Anesthetics
11.6.2 Peripheral Nerve Block Anesthesia
11.6.3 Local Infiltration Anesthesia
11.6.4 Treatment of Severe Local Anesthetic Toxicity
11.7 Intraoperative Monitoring
11.8 Post-anesthesia Management
11.8.1 Post-anesthesia Recovery Management
11.8.2 Postoperative Follow-Up
11.8.3 Postoperative Pain Management
11.9 Airway Management for Cosmetic Head, Neck, and Maxillofacial Surgery
11.9.1 Airway Assessment
11.9.2 Airway Devices
11.9.3 Management of Anticipated Difficult Airway
11.9.4 Unanticipated Difficult Airway
11.9.5 Intraoperative Airway Management
11.9.6 Postoperative Airway Management
11.10 First Aid Treatment of Crisis in Plastic Surgery
11.10.1 Airway Obstruction
11.10.2 Anaphylaxis
11.10.3 Fat Embolism Syndrome
11.10.4 Malignant Hyperthermia
11.10.5 Cardiac and Respiratory Arrest
References
12: Anesthesia for Oral and Maxillofacial Head and Neck Infections
12.1 Introduction
12.2 Origins and Manifestations of Oral and Maxillofacial Infections
12.3 Common Oral and Maxillofacial Infectious Diseases
12.3.1 Pericoronitis of Third Molar
12.3.2 Oral and Maxillofacial Interstitial Infections
12.4 Osteomyelitis of Jaw
12.5 Other Oral and Maxillofacial Infections
12.6 Characteristics of Anesthesia Management
12.7 Anesthesia in Common Use
12.7.1 Pre-anesthetic Visit and Preparation
12.7.2 Pre-anesthetic Medication
12.7.3 The Practice of Anesthesia
12.7.4 Intraoperative Monitoring and Management
12.7.5 Recovery from Anesthesia
References
13: Anesthesia for Oral Maxillofacial and Neck Trauma
13.1 Introduction
13.2 Oral Maxillofacial and Neck Trauma
13.2.1 Maxillary Fracture (Fig. 13.1)
13.2.2 Temporomandibular Joint Injury
13.2.3 Mandibular Fracture
13.2.4 Neck Trauma
13.2.5 Laryngotracheal Injuries
13.3 Anesthetic Management of Oral Maxillofacial and Neck Trauma
13.3.1 Pre-anesthesia Assessment
13.3.1.1 Airway Assessment
13.3.1.2 Assessment of Neurological Function
13.3.1.3 Circulatory Assessment
13.3.1.4 Imaging and Laboratory Tests
13.3.2 Intraoperative Management
13.3.2.1 Airway Management
13.3.2.2 Circulation and Other System Management
13.3.2.3 Maintenance of Anesthesia
13.3.3 Postoperative Precautions
References
14: Anesthesia for Pediatric Oral and Maxillofacial Surgery
14.1 Introduction
14.2 Anatomy and Physiology
14.2.1 Physiology in Children
14.2.2 Cardiovascular Anatomy and Physiology in Children
14.2.3 Anatomical and Physiological Characteristics of Pediatric Airway
14.3 Airway Management Guidelines
14.3.1 Airway Devices and Their Usage
14.3.1.1 Mask
14.3.1.2 Oropharyngeal Airway
14.3.1.3 Nasopharyngeal Airway
14.3.1.4 Laryngoscope
14.3.1.5 Tracheal Tube
14.3.1.6 Tracheal Intubation and Extubation
14.3.1.7 Laryngeal Mask Airway (LMA)
14.3.2 Ventilation Devices and Ventilation Patterns
14.3.2.1 Circulatory Circuit
14.3.2.2 Anesthesia Machines and Ventilators
14.3.3 Principles and Methods of Management of Pediatric Difficult Airway
14.3.3.1 Common Causes of Difficult Airway in Pediatric Patients
14.3.3.2 Assessment of Pediatric Difficult Airway
14.3.3.3 Tools and Methods for Establishing the Airway
14.3.3.4 Pediatric Difficult Airway Management
14.4 Pediatric Anesthesia Techniques
14.4.1 Premedication in the Pediatric Population: Alleviating Anxiety
14.4.2 Routes of Administering Anesthesia
14.4.2.1 Intramuscular Anesthesia Technique
14.4.2.2 Intravenous Anesthetic Technique
14.4.2.3 Inhalational Anesthesia Technique
14.4.3 Anesthesia for Pediatric Cleft Lip and Palate Surgery
14.4.3.1 Classification and Surgical Treatment of Cleft Lip and Palate
14.4.3.2 Characteristics of Anesthesia Management in Cleft Lip and Palate Surgery
14.4.3.3 Anesthesia Techniques in Cleft Lip and Palate Surgery
General Anesthesia
References
15: Anesthesia for Oral and Maxillofacial Surgery in the Elderly
15.1 Introduction
15.2 Characteristics of Elderly Patients
15.2.1 Characteristics of Anesthesia Management
15.2.1.1 High Prevalence of Multiple Systemic Diseases
15.2.1.2 Symptoms of Systemic Diseases May be Atypical
15.2.1.3 Great Individual Differences
15.2.1.4 Common Dementia and Mild Cognitive Impairment
15.2.1.5 Patients Often Take Multiple Medications at the Same Time
15.2.2 Anatomical and Physiological Characteristics
15.2.2.1 Circulatory System
15.2.2.2 Respiratory System
15.2.2.3 Autonomic Nervous System
15.2.2.4 Liver
15.2.2.5 Kidney
15.2.2.6 Metabolism and Endocrine
15.2.2.7 Nervous System
15.2.2.8 Blood, Body Fluid, and Immune System
15.2.2.9 Sensory System
15.2.3 Pharmacological Characteristics
15.2.3.1 Pharmacokinetic Changes [17, 18]
15.2.3.2 Pharmacodynamic Changes [18]
15.2.3.3 Drug Interactions
15.3 Anesthesia Practice in the Elderly
15.3.1 Preoperative Management
15.3.1.1 Preoperative Assessment
15.3.1.2 Preoperative Management Issues Specific to the Elderly
15.3.1.3 Premedication
15.3.2 Intraoperative Management
15.3.2.1 Commonly Used Anesthetics
15.3.2.2 Practice of General Anesthesia
15.3.3 Postoperative Management
15.3.3.1 Postoperative Pulmonary Complications
15.3.3.2 Postoperative Delirium [26, 27]
15.3.3.3 Postoperative Cognitive Impairment [28, 29]
15.4 Conclusion
References
16: Anesthesia for Oral and Maxillofacial Head and Neck Tumor
16.1 Introduction
16.2 Oral and Maxillofacial Head and Neck Tumor and Airway
16.2.1 The Tumor and Airway Obstruction
16.2.2 Tumors and Their Influence on Airway Management
16.2.2.1 Lip Tumors
16.2.2.2 Buccal Cancer Tumor
16.2.2.3 Gingival Tumor
16.2.2.4 Tumor of Palate
16.2.2.5 Tongue Tumor
16.2.2.6 Tumors of the Floor of the Mouth and Oropharynx
16.2.2.7 Maxillary Sinus Cancer
16.2.2.8 Tumor of the Parotid Area
16.2.2.9 Tumor of Chin and Neck
16.2.3 Impact of Prior Treatment on Airway Management
16.3 Oral and Maxillofacial Head and Neck Tumor Surgery and Bleeding
16.3.1 Blood Transfusion for Oral and Maxillofacial Tumor Surgery
16.3.2 Blood Transfusion-Related Problems
16.3.3 Measures to Reduce Blood Transfusion
16.3.3.1 Controlled Hypotension
16.3.3.2 Strict Blood Transfusion Indications
16.3.3.3 Autologous Transfusion Techniques
16.4 Pre-anesthesia Visit and Preparation
16.4.1 Medical History Information
16.4.1.1 History Related to Airway Obstruction
16.4.1.2 History Related to Vital Organ Function
16.4.1.3 Preoperative Radiotherapy History
16.4.1.4 History of Preoperative Chemotherapy
16.4.1.5 Preoperative Medication History and Previous Surgical History
16.4.2 Preoperative Physical Examination
16.4.2.1 Nutritional Status
16.4.2.2 Intubation Conditions
16.4.3 Laboratory and Imaging Examinations
16.4.4 Preoperative Case Discussion and Family Talk
16.4.5 Preoperative Medication and Fasting
16.5 Induction of Anesthesia and Intraoperative Management
16.5.1 Induction Phase of Anesthesia
16.5.1.1 Pre-induction Preparation
16.5.1.2 Intubation Plan
16.5.1.3 Difficult Airway Management [7–9]
16.5.1.4 Intubation Complications
16.5.2 Anesthesia Maintenance Stage
16.5.2.1 Operation on Distance
16.5.2.2 Prolonged Surgery
16.6 Postoperative Management
16.6.1 Extubation
16.6.2 Prophylactic Tracheotomy and Indwelling Tracheal Tube
16.6.3 Postoperative Airway Management
16.6.4 Postoperative Monitoring Management
16.7 Anesthesia for Common Types of Maxillofacial Tumor Surgeries
16.7.1 Surgery of Giant Neurofibroma of Maxillofacial Area
16.7.2 Mental and Cervical Hygroma Surgery
16.7.3 Cervical Lymphatic Dissection and Combined Maxillo-Cervical Radical Surgery
16.7.4 Expanded Craniofacial Radical Surgery
16.7.5 Free Tissue Flap Surgery
16.7.6 Carotid Body Aneurysm Surgery
References
17: Anesthesia for Orthognathic Surgery
17.1 Introduction
17.2 The Scope of Orthognathic and Maxillofacial Deformities and Orthognathic Surgery
17.2.1 Oral and Maxillofacial Deformities
17.2.1.1 Etiology
17.2.1.2 Characteristics of Oral and Maxillofacial Region
17.2.1.3 Examination
17.2.1.4 Classifications
17.2.1.5 Treatment
17.2.2 Orthognathic Surgery
17.3 Anesthetic Management Features
17.3.1 Difficult Airway Management
17.3.2 Tracheal Intubation Route Selection
17.3.3 Remote Management
17.3.4 Intraoperative Blood Loss
17.3.5 Adverse Nerve Reflex
17.4 Anesthesia Methods
17.4.1 General Anesthesia
17.4.1.1 Preanesthetic Evaluation and Preparation
17.4.2 Implementation of Anesthesia
17.4.2.1 Anesthesia Induction
17.4.2.2 Tracheal Intubation
17.4.2.3 Maintenance of Anesthesia
17.4.3 Perioperative Monitoring and Management
17.4.3.1 Respiratory Monitoring and Management
17.4.3.2 Circulatory Function Monitoring
17.4.3.3 Temperature Monitoring
17.4.3.4 Neuromuscular Monitoring and Management
17.4.3.5 Anesthesia Depth Monitoring
17.4.4 Estimation of Intraoperative Blood Loss and Blood Conservation
17.4.5 Controlled Hypotension
17.4.6 Post-Anesthesia Care Unit (PACU)
17.4.7 Anesthetic Complications
References
18: Anesthesia for Nasal and Antral Surgery
18.1 Introduction
18.2 Anatomy
18.2.1 Nose
18.2.1.1 Skeletal Structure
18.2.1.2 Muscles
18.2.1.3 Vessels and Lymphatics
18.2.1.4 Nasal Cavity Divisions
18.2.1.5 Nasal Conchae
18.2.1.6 Vasculature
18.2.1.7 Innervation
18.2.2 Sinus
18.3 Nasal Surgery and Anesthesia
18.3.1 Types of Nasal Surgery
18.3.2 Anesthesia for Different Types of Nasal Surgery
18.3.2.1 Turbinate Reduction Surgery
18.3.2.2 Septoplasty and Rhinoplasty
18.4 Antral Surgery and Anesthesia
18.4.1 Surgical Considerations for Antral Surgery
18.4.2 Anesthetic Management
18.4.2.1 Preoperative Considerations
18.4.2.2 Intraoperative Management
18.4.2.3 Sphenoidotomy
18.4.2.4 Balloon Sinuplasty
18.4.2.5 Sinonasal Debridement
18.4.2.6 Transsphenoidal Pituitary Surgery
References
19: Perianesthesia Monitoring
19.1 Introduction
19.2 Blood Pressure Monitor
19.2.1 Basis of Blood Pressure Monitoring
19.2.2 Noninvasive Blood Pressure Monitoring
19.2.2.1 Tonometry Blood Pressure
19.2.2.2 Pulse Wave Velocity
19.3 Electrocardiogram
19.4 Respiratory System Monitoring
19.4.1 Basic Tools for Monitoring
19.4.1.1 Pulse Oximetry
19.4.1.2 Capnography
19.4.1.3 Precordial/Pretracheal Stethoscope
19.4.1.4 Other Tools
19.4.2 Respiratory Mechanics
19.4.2.1 Hemodynamics and Respiration
19.5 Temperature Monitoring
19.6 Neuromuscular Transmission Monitoring
19.7 Depth of Sedation Monitoring
References
20: Postoperative Pain Management in Oral and Maxillofacial Surgery
20.1 Introduction
20.2 Strategies for Postoperative Pain Management
20.2.1 Standardized Analgesia
20.2.2 Preventive Analgesia
20.2.3 Multimodal Analgesia
20.2.4 Individualized Analgesics
20.3 Pharmacological Aspect of Pain Management
20.3.1 Simple Analgesics
20.3.2 Opioid Analgesics
20.3.2.1 Weak Opioids
20.3.2.2 Strong Opioids
20.3.2.3 Chronic Use of Opioids
20.3.2.4 Opioid-Induced Hyperalgesia
20.3.3 Local Anesthetic
20.3.4 Ketamine
20.3.5 Gabapentinoids
20.3.6 Corticosteroids
20.3.7 α2 Adrenoceptor Agonists
20.4 Psychological and Physical Aspect of Pain Management
20.4.1 Relaxation
20.4.2 Hilotherapy
20.4.3 Acupuncture
20.5 Perioperative Pain Management Techniques
20.5.1 Patient-Controlled Analgesia, PCA
20.5.1.1 PCEA
20.5.1.2 PCIA
20.5.2 Ultrasound-Guided Nerve Block Technique
20.6 Summary
References
21: Oral and Maxillofacial Surgical Intensive Care Unit
21.1 Introduction
21.2 Postoperative Care
21.2.1 Monitoring in the SICU
21.2.2 Special Postoperative Treatment Required for Oral and Maxillofacial Surgical Patient
21.2.3 Hypoproteinemia
21.2.4 Nutritional Considerations
21.3 Handoff
21.4 Ethical Issues
21.4.1 Ethical Issues Between the Patient and the Surgeon
21.4.2 Ethical Issues Between the Patient and the Intensivist
21.4.3 Ethical Issues Between the Surgeon and the Intensivist
References
22: Nursing Considerations for Oral and Maxillofacial Surgical Patient
22.1 Introduction
22.2 Pre-anesthesia Visit and Care for Oral Surgery
22.2.1 Pre-anesthesia Visit
22.2.1.1 Purpose of Pre-anesthesia Visit
22.2.1.2 Contents of the Pre-anesthesia Visit
22.2.2 Pre-anesthesia Psychological Care
22.3 Preparation for Care Before Anesthesia for Oral Surgery
22.3.1 Preparation of Drugs Before Anesthesia
22.3.2 Preparation of Instruments and Tools Before Anesthesia
22.3.3 Preparation of Patients Before Anesthesia
22.4 Monitoring Care During Oral Surgery Anesthesia
22.4.1 Personnel Management and Responsibilities
22.4.2 Key Points of Nursing Care During Anesthesia
22.4.2.1 P: Patient, Position, Protect
22.4.2.2 A: Airway
22.4.2.3 T: Temperature
22.4.2.4 I: Inventions
22.4.2.5 E: Electric Care Monitor
22.4.2.6 N: Narcotics
22.4.2.7 T: Tubes
22.5 Care During the Recovery Period of Oral Surgery Anesthesia
22.5.1 Personnel Management and Responsibilities
22.5.2 Key Points of Anesthesia Recovery Care
22.6 Specification of Anesthesia Care Techniques for Oral Surgery
22.6.1 Tracheal Intubation Nursing Cooperation
22.6.2 Fiberoptic Bronchoscopy Intubation Nursing Cooperation
22.6.3 Deep Venipuncture Nursing Cooperation
22.6.4 Arterial Puncture Nursing Cooperation
22.6.5 Tracheal Tube Extubation Nursing Cooperation
22.6.6 Airway Sputum Suction
22.7 Common Complications and Care of General Anesthesia for Oral Surgery
22.7.1 Complications of Endotracheal Intubation and Nursing Care
22.7.2 Upper Respiratory Tract Obstruction
22.7.3 Bronchospasm
22.7.4 Hypoxemia
22.7.5 Hypotension
22.7.6 Hypertension
22.7.7 Arrhythmias
22.7.8 Cerebrovascular Accident
22.7.9 Hypothermia and Hyperthermia
22.7.9.1 Hypothermia
22.7.9.2 Hyperthermia
22.7.10 Delayed Awakening
22.7.11 Postoperative Delirium and Agitation
22.7.12 Pain
22.7.13 Nausea and Vomiting
References
23: Application of Artificial Intelligence in Oral and Maxillofacial Anesthesia
23.1 Introduction
23.2 Terminology
23.2.1 Artificial Intelligence
23.2.2 Machine Learning
23.2.3 Training Data Set, Validation Data Set, Test Data Set
23.2.4 Deep Learning
23.2.5 Artificial Neural Network
23.2.6 Big Data
23.2.7 Support Vector Machine (SVM)
23.2.8 Decision Tree
23.2.9 Random Forest
23.2.10 Fuzzy Logic
23.2.11 Summary
23.3 Application of AI in Oral and Maxillofacial Anesthesia
23.3.1 Prediction for Hypotension and Hypoxemia
23.3.2 Prediction for PONV
23.3.3 Prediction for Difficult Airway
23.3.4 Artificial Intelligence in Perioperative Management and Remote Control
23.3.5 Application of Automation and Robotic Assistance
23.4 Limitations and Challenges
23.5 Summary
References