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For extra oral procedures, orotracheal intubation is sufficient.
The patient undergoing surgery on the head and neck usually is positioned best with his head and back elevated, his hips and knees flexed, and his feet on a level just above the knees. This position provides better venous drainage in the legs, reduces venous pressure in the head and neck, and permits more physiological cardiopulmonary nary function, since the weight of the viscera is not on the diaphragm. Pressure points on the heels, elbows, and hands must be avoided at the risk of peripheral nerve injury and stasis damage to the skin. The surgeon should discuss with the anesthetist before hand the type of procedure planned, the severity of bleeding anticipated, approximate duration of the procedure and any complication expected. This will greatly help the anesthetist regarding the selection of drugs for induction and maintenance of general anesthesia. Requirement for hypotensive anesthesia or permission to use adrenalin saline injection to reduce bleeding also be intimated to the anesthetist well in advance. For intra oral procedures request the anesthetist for nasotracheal intubation, so that endotrachaeal tube will not interfere with procedure inside the mouth. For extra oral procedures, orotracheal intubation is sufficient. In those cases where there is restricted mouth opening, the cause for the restriction should be discussed with the anesthetist. When the restriction is due to muscle spasm, it will generally be improved after the administration of muscle relaxant. For cases due to other reasons, like temporomandibular joint ankylosis, the anesthetist will have to plan for fiber optic laryngoscopy or blind nasal intubation. No drug should be injected by the surgeon during surgery without the permission of the anesthetist.
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