Background
Maxillomandibular advancement(MMA) is the most effective surgical treatment for patients with obstructive sleep apnea(OSA). However, the perioperative management is crucial to keep patients safe from various critical complications. The aim of this study is to review the perioperative management of patients undergoing MMA.
Method
A retrospective review of medical records was conducted on OSA patients underwent MMA in Craniofacial Center, Chang Gung Memorial Hospital. The parameters monitored are clinical history, anaesthetic evaluation before surgery, intraoperative events, anaesthesia records, recovery room records and progression notes during admission. A comparison of plysomnographic indices before and 3 months after surgery is performed to exam the efficacy of MMA.
Results
Of consecutive 123 patients, aged 32(±9.8) and 80% were male. The BMI was 23.2(±3.2)kg/m2. The Apnea-Hypopnea Indices were 31.06(±23.7) and 4.5(±7.6)/hr before and after surgery. The American Society of Anaesthesiologist(ASA) score was II in 114 and III in 9 patients. During surgery, hypotensive anaesthesia with blood pressure of 50(±2.1)mmHg and HR 74(±7.9)/min were maintained. The average blood loss calculated during surgery was 929(±452)ml. All the patients were extubated in the operating room and kept in recovery room for observation before they were transferred in the ward. Patients stay in the hospital for 3(±1.4) nights before discarge. No patients required reintubation or emergent tracheostomy.
Conclusion
Following proper patient selection, meticulous anesthetic control, and precise surgical conduction, relief of intermaxillary fixation and endotracheal extubation can be a standard procedure. With comprehensive management, OSA patients undergoing MMA may experience a safe and non-critical perioperative care, and expeditious recovery.