Postoperative Respiratory Care On Oral And Maxillofacial Surgery

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In recent years, more patients than previously are at risk for postoperative respiratory complications because of the prolonged time required for oral and maxillofacial operations and the increasing number of elderly patients. The inclusion of the trachea in the operative field can lead to postoperative respiratory complications, even in patients with no respiratory impairment before operation. However, we have found no report describing criteria for the management of postoperative respiratory function in this field.We sought to obtain a better understanding of the current status at dental colleges and dental school hospitals and to study optimal methods for the management of respiratory function after oral and maxillofacial surgery, thereby improving our ability to predict and prevent postoperative respiratory comlpications.A total of 92.3% of the dental colleges and dental school hospitals responded that postoperative patient management was performed by a dental anesthesiologist. Ama … More ng patients receiveing general anesthesia, 4.3% were anesthetized for prolonged periods of 10 or more hours ; virtually all of these patients underwent surgery for malignant tumors. However, few institutions had guidelines for postoperative respiratory management, and less than half had an artificial respirator.At our hospital, about 4.8% of patients undergo prolonged anesthesia. About 97% of these patients are at increased risk for suffering some postoperative respiratory complication, when assessed aqccording to the scoring system for the prediction of postoperative respiratory complications established by Okutsu et al. In fact, however, no serious complications developed in any patient. Such complications were apparently prevented by postoperative respiratory management with an artificial respirator. Patients who undergo prolonged anesthesia therefore require propgylactic artificial respiration for a minimum of 24 hours after operation. Impaired respiratory function was especially present in elderly patients, who had a high incidence of postoperative respiratory complications even if they did not undergo prolonged operations. Postoperatively, tidal volume was lower than before operation, and a decrease in postoperative vital capacity of * 30% was considered an indication for prophylactic artificial ventilation. Less