Anesthetic considerations for orthognathic surgery with evaluation of difficult intubation and technique for hypotensive anesthesia

Anesth Prog. Winter 2000;47(4):151-6.


Orthognathic surgery is carried out to improve facial appearance and/or to improve malocclusion. Usually, patients are young and healthy. However, they may have airway problems. Reinforced silicone low-pressure, high-volume endotracheal tubes and p-xylometazoline (Otrivin) for nasal vasoconstriction reduces problems due to the endotracheal tubes. A head-up position with ventilator and monitoring equipment at the foot end helps the surgeons as well as the surgery. Surgeons may be the cause of endotracheal tube problems. Bleeding is a major problem that may be encountered and is reduced by induced hypotension. During osteotomies, severe bradycardia may occur and may even lead to cardiac arrest. In the early postoperative period, bleeding may be a problem. Later ulceration at the tip of the nose and on the buttocks may be seen if preventive measures are not carried out.

Publication types

  • Review

MeSH terms

  • Adult
  • Anesthesia, General* / methods
  • Blood Loss, Surgical / prevention & control
  • Equipment Design
  • Head / anatomy & histology
  • Humans
  • Hypotension, Controlled*
  • Imidazoles / therapeutic use
  • Intraoperative Complications
  • Intubation, Intratracheal* / adverse effects
  • Intubation, Intratracheal* / instrumentation
  • Malocclusion / surgery
  • Monitoring, Intraoperative / instrumentation
  • Nasal Decongestants / therapeutic use
  • Orthognathic Surgical Procedures*
  • Osteotomy / methods
  • Postoperative Complications
  • Posture
  • Pressure
  • Silicones
  • Ventilators, Mechanical


  • Imidazoles
  • Nasal Decongestants
  • Silicones
  • xylometazoline