Anesthetic considerations for orthognathic surgery: Clinical case report
Abstract
Objective: Selection of ideal anesthetic drugs in maxillofacial surgery.
Material and methods: A 22-year-old male patient weighing 75 kg and 171cm in height, with no premedication. Pre-operative vital parameters were BP 120/70, HR 72× min, SpO2 96%, temperature 36.5 °C, sinus rhythm on 5-lead EKG, capnograpy. The patient was subjected to 5 min of pre-oxygenation through a facial mask. The sniff test was performed, good ventilation was confirmed and a Q-tip impregnated in 0.05% oxymetazoline was applied. An intravenous continuous infusion of dexmedetomidine (solution concentration of 0.8 cg/ml) was initiated at a rate of 0.05 mcg/kg/h with a score of 2 on the Ramsay scale. Induction was initiated with fentanyl 3 mcg/kg, propofol 2 mg/kg, rocuronium 0.6 mg/kg. A No. 7 Murphy endotracheal tube lubricated with a 10% lidocaine spray was introduced through the right nostril down to the nasopharynx. At the start of surgery, the dose of dexmedetomidine was increased to 0.1 mcg/kg/h. Intra-operatively, BP was maintained between 84/55mmHg and 90/53mmHg, and HR between 58 and 76 per minute.
Results: The selection of anesthetic drugs allowed for hemodynamic stability and comfort on awakening.
Conclusion: Anesthesia for orthognathic surgery, as it has evolved today, requires combining different anesthetic techniques in order to ensure that the patient remains calm, comfortable and reassured, with adequate post-operative analgesia.
References
2. Erkan M, Ulkur E, Karagoz H, Karacay S, Basaran G, Sonmez G. Orthognathic surgical planning on three-dimensional stereolithographic biomodel. J Craniofac Surg. 2011;22:1336-41.
3. Kim EJ, Palomo JM, Kim SS, Lim HJ, Lee KM, Hwang HS. Maxillofacial characteristics affecting chin deviation between mandibular retrusion and prognathism patients. Angle Orthod. 2011;81:988-93. Epub 2011 Jun 7.
4. Mahajan R, Ahmed P, Shafi F, Bassi R. Dual bougie technique for nasotracheal intubation. Anesth Prog. 2012;59:85-6.
5. Oncül AM, Cimen E, Küc¸ükyavuz Z, Cambazo˘glu M. Postoperative analgesia in orthognathic surgery patients: diclofenac sodium or paracetamol? Br J Oral Maxillofac Surg. 2011;49:138-41.
6. Rana M, Gellrich NC, Joos U, Piffkó J, Kater W. 3D evaluation of postoperative swelling using two different cooling methods following orthognathic surgery: a randomised observer blind prospective pilot study. Int J Oral Maxillofac Surg. 2011;40:690-6.
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