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OPERASI
ORAL-MAKSILOFASIAL
Classifications:
Tumor Surgery
Palate Surgery
In-Patient Dental Anesthesia
Concerns:
Altered Airway Anatomy
Anesthetic Management
Airway Management
Airway Management
Choice of the technique depends on several factors:
Patient safety
Experience of the anesthetist
Known difficult airway
Requirement: nasal or oral
Post operative jaw wiring
Airway Management
History
Physical Examination
Further Evaluation
Difficult Airway & Algorism
Airway Strategies
History
Laryngospasm frequent
Goldenhar Mandibular hypoplasia and cervical spine abnormality
make laryngoscopy difficult
Difficult Laryngoscopy
Not being able to see any part of the vocal cords
with conventional laryngoscopy
Difficult Intubation
Proper insertion with conventional laryngoscopy
requires either :
a) > 3 attempts
b) > 10min
Airway Management
Different Laryngoscopes,
Awake Laryngoscopy Stylets
Tracheostomy Fiberoptic
Awake
Awake Laryngoscopy
Awake Fiberoptic
Tracheostomy
Retrograde Intubation
AWAKE TECHNIQUES
Glosso-Pharyngeal Nerve IX Nerve
Pyriform Fossa
External :1 cm medial to the superior cornu of the Hyoid
Bone to pierce the thyrohyoid membrane
AWAKE TECHNIQUES
Trachea & Vocal Cord
Atomizer
Injection
AWAKE TECHNIQUES
Laryngoscope Blades
AWAKE TECHNIQUES
McCoy
AWAKE TECHNIQUES
AWAKE TECHNIQUES
SURGICAL AIRWAY
Under General Anesthesia
Laryngoscope Blades
GA TECHNIQUES
McCoy
GA TECHNIQUES
Laryngeal Mask Airway (LMA)
GA TECHNIQUES
LIGHTED STYLETS/LIGHTWAND
Unconventional LMA
Rigid Fiberoptic
laryngoscope
Retromolar
Fiberscope
GA TECHNIQUES
BULLARD LARYNGOSCOPE
GA TECHNIQUES
SURGICAL AIRWAY
Classification According to Mouth Opening
Awake or Sedated
Normal mouth opening
Limited
Retrograde Intubation
Extremely limited
Awake Intubation
Fiberoptic Tracheostomy
Laryngoscopic Under GA
Blind
Techniques
Retrograde Wire
Lighted Stylet/ Blind Nasal
Intubation Combi-Tube
Light wand Intubation
Modified
Techniques
Bullard
Wu Scope
Laryngoscope
NEVER PARALYSE UNTILL POSSIBLE VENTILATION
HAS BEEN ESTABLISHED
Preoperative Management
Intraoperative Management
Malnourished
H/O Alcoholism
MANAGEMENT
Neck dissection
Pre operative radiotherapy
Surgery close to big vessels of neck
Induced Hypotension
Blood Transfusion
Before the decision of blood transfusion the following
points should be considered
Haemodynamic Changes
During radical neck dissection, the traction or
pressure on the carotid sinus and / or stellate
ganglion can cause following:-
Brady-dysrhythmias
Sinus arrest leading to asystole
Wide swings in blood pressure
Prolonged QT Interval
INTRAOPERATIVE MANAGEMENT
Vagolysis by atropine
INTRAOPERATIVE MANAGEMENT
Venous Air Embolism
Diagnosis
Early Detection
Hypoxia
Hypotension
Hypocarbia
INTRAOPERATIVE MANAGEMENT
I. ROUTINE CARE
Haemodynamic Instability
Analgesia
Tracheostomy Care
Humidified Oxygen
Intermittent Suction
Sterile Precautions
Adjustment of cuff pressure to15-
20 mmHg
Complications
THANK
YOU