Secure Fixation of a Nasal Cannula in Orthognathic Surgery Using a Swimming Cap

All rights reserved. www.PRSGlobalOpen.com 1 Shingo Hara, PhD, DDS Masaharu Mitsugi, PhD, DDS Department of Oral and Maxillofacial Surgery Kochi Health Sciences Center Kochi City, Kochi, Japan Seiji Sugimoto, PhD, MD Department of Anesthesiology Kochi Health Sciences Center Kochi City, Kochi, Japan Yukihiro Tatemoto, PhD, DDS Department of Oral and Maxillofacial Surgery Kochi Health Sciences Center Kochi City, Kochi, Japan Sir: I orthognathic surgery, to open up the surgical field on both the left and right sides, the intraoperative cephalic presentation is adjusted laterally on a regular basis. As leakage is caused by the resulting divergence in the site of cannula fixation and/or looseness of the connectors, a method for securing the cannula is required. We herein introduce a method for securing the cannula by means of a swimming cap. First, after attaching the bispectral index (BIS monitoring System, BIS QUATRO; Covidien, Boulder, Colo.) to the forehead, a swimming cap is put in place. In patients with long hair, the hair is gathered and completely stowed within the swimming cap. Next, nasal intubation is performed using a cuffed nasal Ring, Adair, and Elwyn tracheal tube (Covidien). An extension tube (DAR Catheter Mount Extendable; Covidien) is inserted between the nasal RAE tube and the artificial nose (150– 1500 ml Heat and Moisture Exchanger Pleated Mechanical High Efficiency Particulate Air Filter with Gas Monitoring Port, straight; Smiths Medical, London, United Kingdom). A sponge with an attached tube is subsequently adhered to the upper forehead of the swimming cap, and alignment is performed such that the extension tube is drawn toward the cap, while performing fixation with tape above the extension tube using wide tape to wrap the entire cephalic presentation. In order to prevent the cuffed nasal RAE tracheal tube from rising up intraoperatively, fixation using tape is performed to apply tension slightly downward, which also helps to prevent the development of pressure sores around the nostrils. Transparent eye patches are used for protection and included in the surgical field so that the lateral position of the eyes may be used as a distinguishing feature to confirm the position. Space is also reserved at the upper end of the operating table when performing tape fixation. In the present study, we used a swimming cap made of natural rubber to ensure tape fixation (Fig. 1). Using this method, during 2-jaw surgery, the divergence in the orientation of the occlusal plane can be easily checked from the 12-o’clock direction, and alar base cinch sutures can be performed without disturbing the surgical field. Moreover, the operator, first assistant, and second assistant can stand in 3 locations—the patient’s 9-o’clock, 3-o’clock, and 12-o’clock positions, respectively—which is convenient, allowing the patient’s cephalic presentation to be fully moved, thus making this method extremely clinically useful. We have performed orthognathic surgery in more than 2000 cases using this method and experienced no loosening of the connectors during surgery.