Anaesthesia in Craniofacial Malformation Surgery

Infants, children and adults undergoing craniofacial surgery may present with a wide range of diseases and conditions posing an array of challenges to the anaesthesiologist. For all of these patients, airway management and the anaesthetic procedure must be tailored to the surgery being performed and the patient’s specific conditions, while taking into consideration all phases of peri-operative care. Special aspects that differ for anaesthesia in surgery of craniofacially diseased patients from other anaesthesias are: (i) airway management for patients with craniofacial disorders poses many challenges as the normal anatomy is often severely altered; (ii) surgery is performed in the head area, therefore hindering direct access of the anaesthetists to the patient’s intubation side; (iii) surgery is often performed in the neonate or young infancy age; (iv) some of the operations are accompanied by a high blood loss; and (v) some surgical manoeuvres have a direct influence of the tube position. As a consequence, the anaesthesiologist must be familiar with the normal bony and soft-tissue anatomy in the airway and how anatomy is altered by various congenital disorders and through different types of surgery. Additionally, the anaesthesiologist must understand the kind of surgery that is performed in such cases. This chapter gives insight into the special aspects of anaesthesia in craniofacial malformation surgery.