[Anesthesiological Concepts in Pediatric Oral and Maxillofacial Surgery]

Anesthesiological care in pediatric oral and maxillofacial (OMF) surgery is challenging due to the proximity of the surgical field to the airway, a high prevalence of craniofacial malformations, and a high frequency of associated syndromal conditions. This review outlines current perioperative strategies for managing complex cases, such as cleft lip and palate repair and craniosynostosis correction. A comprehensive evaluation of clinical practices and current guidelines, including the 2024 ESAIC airway management recommendations and the 2024 German S3-guideline on cleft lip and palate, was conducted to highlight essential safety protocols and common pitfalls. Preoperative evaluation should focus on identifying obstructive sleep apnea syndrome (OSAS), which affects 3-5% of children and significantly increases the risk of respiratory complications. Specialized syndromes like the Pierre-Robin-sequence or the Treacher-Collins syndrome often present with difficult airways requiring advanced techniques such as video laryngoscopy or fiberoptic intubation. For craniosynostosis repair, high-risk interventions necessitate patient blood management (PBM), including the use of tranexamic acid, cell salvage, and point-of-care viscoelastic coagulation monitoring to manage substantial blood loss. Effective pain management relies on multimodal concepts, integrating regional anesthesia (e.g., infraorbital nerve blocks) to reduce opioid consumption and the associated risk of respiratory depression. In summary, pediatric OMF surgery cases require specialized expertise, standardized algorithms for the difficult airway, and meticulous postoperative monitoring. High-risk patients should be treated in specialized centers with appropriate pediatric anesthetic infrastructure to minimize perioperative morbidity.