Presentation on theme: "Anesthetic management of maxillofacial surgery By: Alaa Samir El Kateb Lecturer of anesthesia and intensive care Ain Shams university."— Presentation transcript:
Anesthetic management of maxillofacial surgery By: Alaa Samir El Kateb Lecturer of anesthesia and intensive care Ain Shams university
Objectives: - Preoperative airway assessment. - Learn how to perform awake intubation. - How to draw a fluid chart. - What is massive blood transfusion and its complications. - Know complications and prevention of hypothermia.
Le fort classification Transverse crossing floor of nose, separating of the palate from the maxilla. Fracture of maxilla, where body of the maxilla is separated from the facial skeleton (pyramidal in shape) The entire maxilla and one or more facial bones are completely separated from the craniofacial skelton
Cont. Preoperative airway evaluation 2- PHYSICAL EXAMINATION: Thick, short & muscular neck Receding or hypoplastic mandible Edentulous, prominent incisors High arched palate, large tongue Presence of ear or hand deformities
Cont. Preoperative airway evaluation Hyomental distance: 2 fingers Thyromental distance: 6.5 cm Mouth opening: (TMJ) 3-4 cm Neck Movement: 35 degree flexion at lower cervical and 80 degree extension at atlanto-occipital
I. Anesthesia of the Nasal Mucosa and Nasopharynx ( Sphenopalatine ganglion and ethmoid nerve) - Lidocaine + epinephrine or lidocaine + phenylephrine - Long cotton-tipped applicators: 1 st : 45 degree to the hard palate 2 nd : parallel to the dorsal surface of the nose - Left in place for 5 minutes - Should be done bilaterally
II. Anesthesia of the mouth, oropharynx and base of tongue (Glossopharyngeal & superior laryngeal nerves ) - Lidocaine gel on tongue blade and patient "sucks“. Peak on set 15 min. OR Lidocaine can be placed in a nebulizer for 5-7 min OR The tongue and posterior pharynx are sprayed with the atomizer.
Nasal intubation - Vasoconstrictor 30-45 minutes earlier. - Insert ETT parallel to hard palate. - Bevel is medial (turbinates are lateral) - During blind nasal: _ Introduce the ETT during inspiration _ You may use capnography
Fiberoptic bronchoscopy - May turn to be an emergency situation. - If to be used, use it as the first choice. - Pull the tongue forward, jaw thrust. - Put the patient in sitting position. - Keep the midline against hard palate. - You may dim room light and use it as illuminating stylet.