Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery SECOND EDITION EDITED BY Patrick A. Ward Consultant Anaesthetist St John’s Hospital NHS Lothian, Scotland and Michael G. Irwin Daniel CK Yu Professor Department of Anaesthesiology University of Hong Kong, Hong Kong Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide.
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Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. Melissa, Florence, and Freddy Ward. May, Ross, Kyle, Alice, Olivia, and Rachel Irwin. Preface from first edition Oral and maxillofacial surgery is the surgical specialty concerned Anaesthetists may also be involved in managing patients experien- with the diagnosis and treatment of diseases affecting the teeth, cing chronic and intractable facial pain and provide anaesthesia for mouth, jaws, face, and neck and represents one of the commonest multiple trauma involving the face.
indications for anaesthesia worldwide. The anaesthetic care of oral Although primarily written for anaesthetists, this textbook will and maxillofacial patients requires specific knowledge and skills on also be of interest to maxillofacial surgeons, anaesthetic practi- the part of the anaesthetist. An understanding of the subject matter tioners, anaesthetic nurses, and Operating Department Practitioners is fundamental to the safe practice of anaesthesia. involved in providing anaesthesia for dental, oral, and max-illofacial This textbook is intended to go some way to address this need.
We would also expect the work to be of interest to those an- The anaesthetist can be called upon to provide anaesthesia for pa- aesthetists currently in training and studying for their professional tients presenting with impacted or carious teeth, infections of the examinations. mucosa and adjacent structures, complex facial injuries, head and Ian Shaw neck cancers, salivary gland disease, facial disproportion, tem- Chandra Kumar poromandibular joint disorders, cysts, and tumours of the jaws. Chris Dodds Preface Anaesthesia for oral and maxillofacial surgery encompasses a perspective on existing topics, with the addition of new chap- wide range of procedures, treatments, and interventions for an ters on human factors in anaesthesia and surgical complications, array of pathologies affecting the teeth, mouth, and jaw. There is written from the surgeon’s perspective.
frequently overlap with other related surgical specialties such as The safe perioperative care of patients undergoing oral and max- otorhinolaryngology, neurosurgery, plastic surgery, and recon- illofacial surgery necessitates a comprehensive knowledge and structive surgery. Since the publication of the first edition of the understanding of the specific challenges posed by this cohort, and Oxford Textbook of Anaesthesia for Oral and Maxillofacial Surgery their underlying pathologies and comorbidities, including a full ap- in 2010, this subspecialty has continued to develop, with pro- preciation of the implications of a ‘shared airway’. This textbook is cedures and techniques evolving, new guidelines and standards primarily intended as a reference tool for anaesthetists of all grades, being introduced, and new research evidence becoming avail- but will also be of interest to maxillofacial surgeons, anaesthetic able. This second edition has been completely updated by a new practitioners, anaesthetic nurses, recovery and intensive care nurses, group of authors, adding an original, contemporary, and fresh and operating department practitioners.
Contents Abbreviations xv 3. Surgical airway 29 Contributors xvii William P. Bradley and Gordon A. Preoperative assessment 1 Anatomy 29 Roger H.
Ho and David M. Lam Elective tracheostomy 30 Introduction 1 Percutaneous dilatational tracheostomy 30 Range of procedures 1 Surgical tracheostomy 31 Airway evaluation and planning 1 Complications of surgical and percutaneous tracheostomy 33 Pathology-specific considerations 2 Submental tracheal intubation 33 Environmental considerations 4 Emergency front of neck airway 34 Evaluation of comorbidities 4 Use of ultrasound 36 Preoperative risk stratification 10 Conversion techniques 37 Perioperative management of medications 12 Retrograde intubation 38 Conclusion 15 Jet oxygenation 39 2. Difficult airway 19 Conclusion 40 Craig Lyons and Ellen P. O’Sullivan Acknowledgements 40 Introduction 19 Airway assessment 19 4.
Regional anaesthesia 43 Shona Love and Ian Bailes The airway plan 20 Positioning 20 Introduction 43 Preoxygenation 20 The face 43 Neuromuscular blockade 20 Anaesthetizing the face 46 Apnoeic oxygenation 21 The scalp 47 Bag mask ventilation 21 Anaesthetizing the scalp 47 Supraglottic airway devices 21 The nasal cavity 47 Direct laryngoscopy 21 Anaesthetizing the nasal cavity 48 Videolaryngoscopy 22 The mouth 49 Awake tracheal intubation 22 Anaesthetizing the mouth 49 Fibreoptic intubation 22 Awake videolaryngoscopy 24 The pharynx 50 Awake tracheostomy 24 Anaesthetizing the pharynx 51 Retrograde intubation 24 The larynx 51 Blind nasal intubation 25 Anaesthetizing the larynx 52 Cricothyroidotomy 25 Awake tracheal intubation 52 Intubation for maxillomandibular fixation 25 Complications of regional anaesthesia 53 Tracheal extubation 26 Conclusion 54 Human factors 27 Conclusion 27 xii Contents 5. Dental anaesthesia 83 Indu Mitra Jennifer Gosling and John Myatt Introduction 57 Introduction 83 Imaging modalities 57 Background and history 83 Trauma imaging 58 Preoperative assessment 84 Dentition 59 Consent 84 Craniofacial anatomy 60 Anaesthesia 86 Craniofacial fractures 60 Postoperative complications and follow-up 89 Infection 63 Sedation 89 Tumours 63 Conclusion 90 Conclusion 64 9. Sedation 65 Corina Lee James W. Mann and Vivian Yuen Introduction 93 Introduction 65 Orofacial aesthetic surgery 93 Aims of sedation 65 Preoperative assessment 93 Advantages of sedation 66 Anaesthesia for orofacial aesthetic procedures 94 Potential complications of sedation 66 Surgical requirements for orofacial aesthetic procedures 96 The ideal sedative agent 67 Postoperative priorities for orofacial aesthetic surgery 97 Pharmacology of sedative agents 67 Considerations for specific orofacial surgical procedures 97 Synergy of agents 70 Considerations for non-surgical facial aesthetic Conduct of sedation 71 procedures 102 Conduct of surgery 72 Revision surgery 104 Safety and guidelines 72 Acknowledgements 104 Preoperative assessment and preparation 73 10.
Orthognathic surgery 107 Monitoring 74 Patrick A. Ward and Michael G. Irwin Equipment availability 74 Introduction 107 Training and personnel 74 Preoperative assessment, preparation, and planning 107 Recovery and discharge 75 Preoperative consent and premedication 110 Conclusion 75 Intraoperative management 110 7. Hypotensive anaesthesia 77 Tracheal extubation and emergence 117 Kimberley Hodge, Patrick A.
Ward, and Michael G. Irwin Postoperative management 118 Introduction 77 Specific orthognathic procedures 121 Background 77 Conclusion 121 Physiology 77 11. Paediatric surgery 123 Indications 78 Silky Wong and Theresa Wan-Chun Hui Contraindications 78 Introduction 123 Conduct of deliberate hypotensive anaesthesia 79 Preoperative evaluation 123 Pharmacological techniques for hypotensive anaesthesia 79 Premedication 123 Non-pharmacological techniques to minimize blood loss 82 Fasting 124 Conclusion 82 Identification of the difficult airway and its management 124 Contents xiii Induction of anaesthesia 125 Secondary survey 157 Tracheal tube selection 125 Inhalation injury 158 Fluid management 126 Systemic gaseous toxins 158 Analgesia 126 Thermal injury to the airway 159 Postoperative nausea and vomiting 126 Smoke injury to the lungs 160 The compromised airway in the postoperative period 126 Chemical burns 161 Oromaxillofacial procedures 127 Other considerations in patients with airway burns 161 Craniofacial procedures 128 Prognosis in the airway burns patient 162 Orthognathic procedures 129 Critical care therapy 162 Anaesthesia for craniofacial and orthognathic procedures 130 Immediate major burn debridement 162 Surgery for trauma 131 General considerations in burns anaesthesia 162 Minor oromaxillofacial procedures 131 Burns pharmacology 163 Conclusion 132 Long-term considerations 164 Conclusion 164 12. Duffen and David J.
Malignancy 167 Introduction 135 Michelle Gerstman, Orla J. Lacey, and Cyrus Kerawala Epidemiology 135 Introduction 167 Pathophysiology 135 Anatomical distribution of malignancy 167 Microbiology 136 Risk factors for malignancy 167 Antimicrobials 137 Types of surgical procedures 167 Antibiotic prophylaxis 138 Treatment options 167 Clinical assessment 138 Anaesthetic assessment 169 Management of the uncomplicated patient 139 Fourth National Audit Project 170 Management of the patient with serious complications 139 Difficult Airway Society 2015 guidelines 170 Tracheal extubation and postoperative management 142 Awake airway management techniques 170 Secondary infections 142 Oxygenation techniques 172 Conclusion 143 Airway devices 173 Anaesthesia and perioperative care 173 13. Trauma 145 Rebecca Thurairatnam and Fauzia Mir Tracheal extubation techniques 174 Range of procedures 175 Introduction 145 Conclusion 177 Epidemiology and aetiology 145 Classification of fractures 145 16. Postoperative care and planning 179 Associated injuries 147 Joshua H.
Rassekh, and Andrew Herlich Emergency airway management 147 Introduction 179 Airway guidelines and maxillofacial trauma 149 Enhanced Recovery After Surgery 179 Anaesthetic management of maxillofacial trauma 150 Postoperative levels of care and monitoring 180 Conclusion 153 Anaesthetic considerations 180 Oral hygiene 181 14. Burns and inhalational injury 155 Caroline A. Nicholas and Tim N. Vorster Tissue oedema 181 Cognitive recovery 181 Introduction 155 Difficult airway identification 181 Epidemiology 155 Analgesia 182 The emergency department acute major burn admission 155 Obstructive sleep apnoea syndrome 183 Resuscitation 156 xiv Contents Venous thromboprophylaxis 183 Challenges of oromaxillofacial anaesthesia 201 Perioperative nutrition 183 Task management 202 Neurological sequelae 184 Situation awareness 202 Perioperative antimicrobials 184 ANTS applied to situation awareness 203 Procedure-specific considerations 184 Decision-making 204 Conclusion 189 ANTS applied to decision-making 204 Teamwork 205 17.
Surgical complications 191 Justin P. Curtin and Gene Lee ANTS applied to teamwork 205 Introduction 191 Team communication 205 Airway management 191 Team performance 206 Extubation planning and postoperative airway Crisis resource management and simulation training 206 compromise 192 Cognitive aids 207 Return to theatre! 193 Continued path towards improving patient safety 207 Bleeding 194 Conclusion 207 Infection 194 19. Orofacial pain 211 Other perioperative complications 194 Stanley Sau Ching Wong and Chi Wai Cheung Procedure-specific complications 195 Introduction 211 Conclusion 198 Assessment for orofacial pain 211 18.