Pre- and Peri-operative Care in Orthognathic Surgery - Anesthesiology and CMF-Surgery

Modern perioperative care is complex and involves a large number of staff from multiple disciplines. Patient outcomes depend on well-designed processes, consistent clinical practice, and effective communication. The peri- and postoperative care should be a unified process of multiple coordinated steps (Kwon and Laskin, Quintessence Publishing 2001; Kerridge, Best Pract Res Clin Obstet Gynaecol 20(1):23–40, 2006). The flow of information in the surgical process is based on standardized pre-, peri-, and postoperative checks, notes, and orders in the operating room, the recovery ward, and the normal patient ward. Preoperative protocol establishes what is thought to be the pathology of the patient and what procedure is planned for the operation an anesthesia. It indicates that the appropriate preoperative tests have been performed and reviewed. It also confirms the presence of an informed consent document (operative permit). Surgical care provided to a patient requires a written, signed, informed consent document. Often referred to as an “op permit,” it is an essential part of the medical record. It must be properly completed prior to any invasive, anesthetic, or other procedure that involves any significant risk to the patient. Preoperative checks and orders assure that the patient is ready for surgery and all preoperative medical instructions have been performed. All necessary laboratory exams, X-rays, consultations, and permits must be ordered in a timely manner to ensure their availability before surgery. Similarly, preoperative determination of the intubation manner between anesthesia and CMF surgery is essential in particular with regard to possible intubation problems. Perioperative notes include the anesthesia induction, anesthesia maintenance, and intraoperative ongoing monitoring and documentation of the patient’s vital functions, as well as documentation of all perioperative prophylactic measures taken for a successful without adverse events postoperative course.