Anesthesia for Oral and Maxillofacial Surgery

Description

This book reviews and describes anesthetic management of patients during oral and maxillofacial surgery. It covers applied anatomy of oral and maxillofacial surgery, difficult airway management and anesthetic techniques. The anesthetic management for patients with oral and maxillofacial disorders such as head and neck infection, head and neck injuries, and head and neck malignancy is also discussed. It will be a concise, up-to-date reference for specialists in anesthesiology, as well as practitioners in oral and maxillofacial surgery. It aims to share up-to-date knowledge and practical techniques with those who work in the fields related to 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