ORIF Mandible

• Assess nasal patency
• Co-phenylcaine to chosen nostril
• Consider awake FOI vs asleep VL with patient depending on airway difficulty

Asleep Videolaryngoscopy

• PropofolTCI
• RemifentanilTCI, Cet 4–5
• Rocuronium0.6mg/kg
• AirwayETTNorth-facing RAE / reinforced nasal
• Confirm ETCO₂ + bilateral air entry; note tube length

Awake Fibreoptic

• Follow awake FOI recipe: HFNO, topicalisation (Lidocainemax 9 mg/kg LBW), optional RemifentanilTCI Cet 1–2
• AirwayETTNasal
• Induce only after two-point check (view + capnography)
• Propofol2-3mg/kg ± RemifentanilCet 4, then continue TIVA maintenance

Maintenance

• PropofolTCI
• RemifentanilTCI

Analgesia

• Morphine0.1 mg/kg (before remi off)
• Paracetamol1 g
• Diclofenac75 mg (if suitable)
• Magnesium sulphate2.5–5 g
• Local anaesthetic infiltration by surgical team

Anti-emetics

• Ondansetron

• Remove throat pack with surgeon
• Suction under direct vision
• Sugammadex2 or 4 mg/kg for reversal
• Awake extubation (blood / swelling / intermaxillary fixation risk)

Analgesia

• FentanylRecovery use only
• Paracetamol1 g
• Ibuprofen400 mg
• Dihydrocodeine30 mg PRN

Anti-emetic

• Ondansetron4 mg
• Cyclizine50 mg

• Shared airway with OMFS
• Airway plan: videolaryngoscope under GA or awake fibreoptic (depending on mouth opening, trismus, swelling, blood in airway)
• Confirm wire cutters available if intermaxillary fixation planned
• Throat pack in / out checklist with surgeon