Incidence of General Anesthesia-related Adverse Events in Maxillofacial Surgery among Patients with Congenital Heart Disease

<p>  To determine the incidence of general anesthesia-related adverse events in maxillofacial surgery among patients with congenital heart disease (CHD), we surveyed patients who underwent scheduled maxillofacial surgery under general anesthesia between January 2020 and December 2022 at the Osaka Women’s and Children’s Hospital. The incidence of adverse events was then compared between patients with and those without CHD. Among the maxillofacial surgery cases, 8.2% (91/1,111) of the patients had CHD ; this percentage has been increasing in recent years. The median age of the patients was 6 years, and more than half of the surgeries were related to cleft lip and palate. The incidence of adverse events among patients with CHD was 36.3%, which was significantly higher than that among patients without CHD (14.8%) ; the incidences of hypotension (7.7%) during anesthesia, bradycardia (5.5%), and hypoxemia after extubation (17.6%) were particularly high. A logistic regression analysis using adverse events as the objective variable revealed that CHD, genetic and chromosomal abnormalities, and intellectual disability were independent factors in the occurrence of adverse events. In addition, a relatively large number of patients with CHD comorbidities were managed in the intensive care unit (ICU) postoperatively, and dexmedetomidine was administered in many cases. Among patients with CHD who require maxillofacial surgery, the presence of other preoperative comorbidities, intraoperative circulatory changes, airway problems after extubation, and the need for postoperative sedation in the ICU must be considered.</p>