Postoperative monitoring following jaw surgery is essential

The effect of anesthesia on the ventilatory functions of patients with Maxillo-mandibular fixation

BACKGROUND

Maxillo-mandibular fixation (MMF) is a procedure still routinely practiced in developing countries.

AIM

To determine the variations in pulmonary functions readings between cases treated under general anesthesia (GA) and those treated under local anesthesia (LA).

METHODOLOGY

A descriptive hospital-based study of 106 patients was carried out from January 2011- December 2012. Information was obtained using a questionnaire and all study subjects had their baseline lung functions and their post-operative daily lung function parameters measured for the first week and then weekly for the next five weeks. The data obtained were analyzed using SPSS version 16 and a P-value of ≤0.05 was considered significant.

RESULTS

A total of 85 males and 21 females participated in the study. The means for age was 30.62±8.06, weight 63.92± 9.96 and BMI 23.21± 3.14 while the means for the pre-operative FVC, FEV_1, and PEF_R were 3.71 ± 0.70, 3.14± 0.51 and 8.18± 1.61 respectively. There was a statistically significant drop (p< 0.05) in the FVC, FEV₁ and PEF_R in the first post operative week. The drop in the lung function parameters were similar between the GA group and the LA group.

CONCLUSION

Maxillo-mandibular fixation causes a significant fall in pulmonary function parameters especially in the first 48 hours post-operatively irrespective of whether general or local anaesthesia was used at surgery. The pulmonary functions should be further monitored for more than 48 hours after surgery.

Manikin model with breathing tube for wire-guided percutaneous cricothyrotomy in patients applying an intermaxillary fixation

Jaw fracture surgery or orthognathic surgery usually involves the application of an intermaxillary fixation (IMF). Obstructions that cannot be relieved by suction require an immediate release of IMF wires, but releasing the IMF may damage the surgical alignment of the facial bones. The mean time taken to release the jaws was an average of 2 minutes 9 seconds by hospital staff involved in caring for these patients. The aims of this study were to introduce a training model for wire-guided percutaneous cricothyrotomy in the patients applying an IMF and to perform the procedure for medical students. Our model consisted of a facial mannequin, a plastic breathing tube, 2 rolls of tapes, and a reservoir bag. The inner parts of the 2 used rolls of tape represent tracheal/cricoid rings (1-inch width for thyroid and half-inch width for cricoid), and the space between them represents the cricothyroid membrane, which is wrapped with Peha-Haft. A surgeon demonstrated the technique on the model, and then, 60 medical students who had never attended airway-training courses applied the Melker cricothyrotomy kit on the model. All 60 students completed the procedure successfully. The mean (SD) time needed to insert a cricothyrotomy catheter of the medical students was 175 (50) seconds (range, 76-297 s). Most of the students (54; 90%) performed it within 4 minutes; more than half (33; 55%), within 3 minutes. With our manikin model and Melker cricothyrotomy kit, 60 medical students completed the procedure successfully. This model can be useful to cricothyrotomy training for medical personnel.