Abstract
A 23-year-old female with skeletal mandibular prognathism was scheduled for orthognathic surgery. Since she had moderate asthma, consideration was given to avoidance of respiratory complications before, during and after surgery.
1. Preoperatively, reversibility of bronchial constriction was evaluated with a spirogram before and after inhalation of a bronchodilator. The patient had been prescribed bronchodilators and bronchodilator aerosols, and antibiotics were administered to prevent postsurgical infections.
2. Anesthesia was induced with intravenous administration of midazolam and ketamin. During surgery, the patient was maintained in anesthesia with nitrogen oxide, oxygen and sevoflurane. Aminophyline was administered intravenously to avoid an asthma attack. The patient underwent sagittal split ramus osteotomy. Rigid fixation with titanium screws and intermaxillary traction with elastics after surgery were performed to avoid complications after surgery.
3. One day after surgery, despite receiving intravenous aminophylline, this patient had an asthma attack, but it was successfully recovered in fifteen minutes with bronchodilator aerosols after removing the nasogastric tube. Stimulation of the larynx by the nasogastric tube may have induced the attack.
4. Orthognathic surgery can be performed on an asthmatic patient if the attending physician is able to prevent asthma attacks or takes proper measures against the occurrence of attacks in close consulation with an asthmatic medical specialist.
