Anesthetic management for orthognathic surgery under ERAS protocol: a narrative review

This review aims to analyze the evolution and implementation of Enhanced Recovery After Surgery (ERAS) protocols in orthognathic surgery, particularly focusing on anesthesia management including core components: multimodal analgesia, intraoperative hemorrhage control, postoperative nausea and vomiting (PONV) prevention, airway management, glucocorticoid application, and perioperative fluid management. The goal is to identify key strategies for improving patient recovery through evidence-based practices.

A narrative review of existing literature was conducted, analyzing studies published on ERAS and anesthesia management in orthognathic surgery from 1997 to the present.

This review highlights the progress of ERAS protocols, which optimize perioperative care by focusing on multimodal anesthesia management, controlled hypotension, and strategies to alleviate pain, nausea, and inflammation via the aforementioned anesthesia-specific interventions. It is evident that ERAS can reduce opioid consumption, shorten hospital stays, and improve overall recovery. However, no standardized ERAS protocol has been universally adopted for orthognathic surgery.

ERAS protocols have shown promise in improving patient outcomes in orthognathic surgery, but further research and the development of a unified protocol with standardized anesthesia management specifications are needed. Multidisciplinary collaboration remains crucial to effectively implement ERAS practices.

This review provides insights into the application of ERAS in orthognathic surgery and offers guidance for clinical practice, particularly regarding the optimization of anesthesia management with evidence-based anesthesia-specific ERAS interventions to promote faster recovery and minimize complications.