Position: Supine, arms tucked
Time: 1-2 hours (average)
Blood Loss: High (200 – 500 ml)
Post-op Pain: Moderate (3-6)
Maintenance Paralytic: Preference

Blood Loss – initial cut-down can result in significant blood loss. It is recommended to keep the systolic blood pressure between 80-90 where not contraindicated. Gradually allowing the pressure to rise after the cut-down allows the surgeon to troubleshoot bleeding issues. Bleeding problems can manifest if the patient is kept hypotensive throughout the case with a sudden rise at emergence.

Shared airway – The procedure will take place intraorally, so make sure the airway is secure!

Oral airway – if the patient wakes up and bites the oral airway, it can bend or disfigure the plates placed during the surgery. Where not contraindicated, wake deep and use nasal trumpets.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.