Postoperative problems may be similar to those described in Chapter 19 including respiratory and cardiovascular problems (eg airway obstruction, cyanosis). In addition, there may be problems such as failure to breathe, delayed awakening, postoperative nausea and vomiting, inadequate neuromuscular function (following the use of NMBDs), shivering and temperature disturbances.

Meticulous intraoperative care can substantially reduce these problems such as meticulous airway management, confirmation of adequate return of neuromuscular function, postoperative nausea and vomiting prophylaxis and prevention of intraoperative hypothermia.

Both anaesthesia for maxillofacial and ENT surgery may require ‘sharing’ the airway with the surgeon, or at least having limited access to the airway and a number of airway devices are available to ensure the patient has a patent and secure airway at all times.

A number of areas need to be considered. Many patients are children, there is a risk of airway contamination with blood, bone teeth etc. In particular, perioperatively, it is easy to underestimate blood loss blood can be swallowed. Another area is patients with head and neck cancers. These patients may not only have a number of comorbidities (heavy alcohol and/or nicotine use, cachexia and weight loss) but have very difficult airways to manage because of tumour involvement or radiotherapy.

Patients with significant airway problems (from infection, tumour, radiotherapy) may need awake fibreoptic tracheal intubation)

Middle ear surgery may also require induced hypotension and prophylaxis of postoperative nausea and vomiting.

Intraoperative problems may arise from a number of anaesthetic, surgical or medical issues.

These include respiratory problems such as airway and breathing problems (airway obstruction, laryngospasm, wheeze, aspiration of gastric contents) and cardiovascular problems such as cardiac arrythmias, hypotension and hypertension. In particular the avoidance of hypoxia and hypercarbia is crucial as well as reliable venous access, ensuring adequate delivery of anaesthesia, analgesia and ensuring the correct monitoring is attached. It is important to exclude drug interactions/reactions and ensure the correct dose has been administered.

Surgical problems can occur secondary to stimulation, revealed and occult haemorrhage and problems arising causing interference with venous return or lung expansion.

Preexisting or new medical problems (e.g. myocardial infarction) should also be considered alongside the above.