[Anesthesiological problems in maxillo-facial surgical interventions and reconstructive plastic surgery]

11 years of anaesthesiological experience in maxillofacial and reconstructive plastic surgery (1-4-1966/1-4-1977) are reviewed. The problems connected with these operations are examined. On the basis of localizations, types of operation and surgical requirements, the problems of greatest importance in these branches of surgery may be indicated in the following 5 parameters: 1. Control of the respiratory ways with naso-tracheal intubation under direct view or blind (more than a thousand cases), oro-tracheal intubation: their indications and contraindications as alternatives to pre- intra- and postoperative tracheotomy. 2. Local control of bleeding. 3. Arousal and prevention of possible postnarcotic complications. 4. Prevention and treatment of postoperative oedema. 5. Nutrition of the patient undergoing surgery. In the interests of history, the superseded problem of whether to use local anaesthesia and general anaesthesia in maxillofacial surgery is mentioned and the various problems are discussed exhaustively. Personal anaesthesiological conduct is then specified in relation to the parameters examined and results reported. The importance in certain endo- and extraoral operations of prolonged intubation in the immediate postoperative period (10-15-30 hours) with respect to the indication for postoperative tracheostomy is highlighted. Apart from certain special pathological situations, tracheostomy is rather exceptional and is no longer employed on a routine basis as it was 2-3 years ago.