Combined oral orthodontic surgery is a complex and challenging arthropod surgery designed to correct serious abrasions. Since the operation involves multiple parts, such as the mouth, the cheekbones, the length of the operation and the complexity of the operation, it is essential to choose the appropriate anaesthesia programme and to adjust it in a timely manner, as appropriate, during the operation, which is directly related to the success of the operation and the safety of the patient.
I. Symptoms of combined oral aberration
(i) Surgery and complexity
The surgery was performed mainly in the mouth and face of the cheek, including amputation, movement and fixation of upper and lower cheekbones. These operations involve complex anatomy structures, such as teeth, dental chords, gillbones, neurovascular beams, etc., and the operation process requires precision in order to ensure the exact adjustment of the bite relationship and the position of the cheekbones.
(ii) Length of operation
Combined oral orthodontic surgery usually takes longer periods, ranging from hours to 10 hours. The long operation places higher demands on the maintenance of anaesthesia and the management of the physiological function of the patient.
(iii) Airway management challenges
The area of the operation is close to the airway, which can easily be affected during the course of the operation, in particular in the case of abrasions and stasis. In addition, the operation of the mouth may lead to misentry of airways, such as blood, secretions, and increase the risk of air-traumatization and misuse.
II. Common anesthesia programmes
(i) All-body anesthesia
1. Inducing phase: Transvenial rapid induction may be used, with commonly used drugs such as propaphenol, itomite, fentanyl, etc. Propyrophenol has a fast-acting and fast-awakening characteristic, but may cause a decrease in blood pressure; it has a relatively small effect on blood flow mechanics, but may have adverse effects such as muscle spasms. Care should be taken during the induction process to keep the airways open and to use larynx mirrors to assist intubation.
2. Maintenance phase: Increased use of static suction complexes. Inhalation of anaesthesia, e.g., heptafluoroalkanes, has the advantage of anaesthesia ‘ s dialysis and abstermination; intravenous anesthesia can choose to maintain a stable anaesthesia by a continuous infusion of propol or refentanyl, etc. At the same time, muscle laxatives are added in due course to the needs of the operation to ensure a clear vision and smooth operation.
3. Awakening period: after the surgery, the patient is able to recover from his or her self-respiratory activity, his or her muscles are relaxed, he or she is conscious of his or her consciousness and removes his or her trachea. The awakening process needs to be smooth, avoiding coughing, manoeuvring, etc., and preventing blood pressure fluctuations and gastric complications. (ii) Selection of the mode of intubation
1. Intubation through the nasal trachea: In the case of joint oral aberration, the nusal trachea is a common method. It avoids interference with the operation through oral intubation, while maintaining relative stability during the operation. However, the nasal intubation may cause damage to the nasal mucous membranes, requiring attention to operational techniques and the selection of appropriate catheters.
2. Special bronchial catheters: In some cases, enhanced catheters or specially designed catheters specializing in oral face surgery may be used to adapt to surgical requirements and to improve the safety of air-channel management.
III. Adjustment of the anaesthesia programme
(i) Adjustments to surgical progress
1. Anaesthesia depth: Timely adjustment of anesthesia depth based on the irritation intensity of the operation, such as bone amputation, drilling, etc. If the surgery is highly irritated and the depth of the anaesthesia is insufficient, the patient may have a reaction such as physical aerodynamics, increased blood pressure and a high heart rate; conversely, excessive anaesthesia can lead to low blood pressure, respiratory inhibition, etc.
2. Muscle laxity: Steps that require precise operation, such as gillbones, to ensure sufficient muscle laxity. If the muscles are not loose enough, it may affect the surgery ‘ s adjustment of the position of the gillbones; the long-term use of muscle laxants requires attention to their accumulation and post-operative residues.
(ii) Adjustment to the patient ‘ s physiological changes
1. Hemodynamic changes in blood flow: close monitoring of blood pressure, heart rate, electrocardiogram, etc. of patients. In case of hemodynamic instability, vascularly active drugs can be used if blood pressure is low, high blood pressure can appropriately deepen anesthesia or adjust with pressure relief drugs.
2. Respiratory function changes: Pay attention to the frequency of the patient ‘ s respiration, tide, air pressure, etc. If there is an increase in the barometer pressure, it may be the case that the catheter is plugged, a discount or a bronchial convulsion has occurred, which needs to be addressed in a timely manner.
The choice and adjustment of anaesthesia programmes for combined oral aberrations is a complex and delicate task. Anaesthetist needs to take full account of the individual and surgical characteristics of the patient, to choose the appropriate anaesthesia methods and drugs, and to be flexible in the course of the operation in order to ensure the safety and comfort of the patient during the anaesthesia, to ensure the successful completion of the operation and to promote a good post-operative recovery for the patient.
