Anaesthesia for Maxillofacial Surgeries: A 10 Year Review in ABUTH Zaria

Abstract

Background: Maxillofacial surgeries pose lots of challenges to the attending anaesthetist especially as regards emergency airway management. The anaesthetist must be conversant with the techniques and appliances of managing both anticipated and unanticipated difficult airway.
Objective: To present a retrospective review of the anaesthesia for 952 cases of maxillofacial surgeries treated over a period of ten years (2006 - 2015) in Ahmadu Bello University Teaching Hospital (ABUTH) Shika-Zaria, Nigeria.
Methodology: After obtaining ethical approval from the hospital Ethics Committee, data were sourced from the clinical records of 952 cases of maxillofacial surgeries in ABUTH. All the patients had pre-anaesthetic assessment by the attending anaesthetist and informed consents were taken. Decision for the intubation technique was based on airway assessment by Mallampati classification, thyromental distance and atlanto-axial mobility. All patients were premedicated with intravenous atropine 10mcg/kg on the operating table.
Results: Our findings identified fractures as the most common injury suffered by the patients, affecting 264 patients (27.7%), followed by ameloblastoma 168 patients (17.6%). Patients who had foreign body in the nostril were 10 (1.1%), while 165 (17.3%) were unclassified cases. Nasal intubation with direct visualization of vocal cords occurred most frequently (62.9%), followed by fibre-optic intubation (24.9%). Oral intubation was carried out in 44 (4.6%) patients, while tracheostomy was performed in 72patients (7.6%). In 281patients with anticipated difficult airway, fibre-optic intubation was attempted in all cases with asuccess rate of 84.7%.
Conclusion: Difficult airway in maxillofacial surgeries is common anddemands special attention. Time of surgery should be carefully planned allowing reduction of anaesthetic morbidity and mortality.

Key words: Difficult airway, Premedication, Anaesthetic plans, Fibre-optic intubation, Tracheostomy.