The most important issue for the anesthesiologist is maintenance of an airway. Postextubation obstruction is more likely due to a combination of a closed palate, a small mandible pushing the tongue into a small pharynx, swelling (hypopharyngeal, subglottic, or flap edema), blood, and the residual effects of anesthesia. There could also be swelling of the tongue due to mouth gag placement during surgery. In the case of a pushback procedure with or without a pharyngeal flap, the obstruction is due to the new posterior position of the palate and the pharyngeal flap.

The anesthesiologist must also be aware of potential problems such as bleeding, neurosensory disturbances, increased oral secretions, a retained throat pack, and hypothermia. Blood loss is not an anesthetic complication, but its replacement is an anesthesiologist's responsibility, as is prevention of aspiration. Patients can experience paresthesias in the cheek after surgery. Very rarely, the sensory disturbance can be permanent. Hypothermia delays emergence and can produce metabolic acidosis and respiratory and myocardial depression.

References

• Cladis F, Grunwaldt L, Losee J. Anesthesia for Plastic Surgery. In: Davis PJ & Cladis, FP, ed. Smith's Anesthesia for Infants and Children. 10th ed. Elsevier; 2021: 957-963.
• Goldstein JA, Baker SB. Rodriguez ED, Losee JE, Neligan PC. Cleft and craniofacial orthognathic surgery. Plastic Surgery. Craniofacial, Head and Neck Surgery and Pediatric Plastic Surgery. Vol 3. 4th ed. Elsevier; 2018:660-677.