Most AAOMS Members Have Not Adopted the ASA Recommended NPO Guidelines

Poster Session The findings of this study indicated that the time of day did not cause an increased usage of medication in the afternoon, and providers did not deviate from their normal in terms of medication usage in the afternoon, signifying that patients can be scheduled in the afternoon without added difficulty of sedation.

foods on their websites when compared to the current ASA Guidelines prior to ambulatory anesthesia. The ASA Guidelines are based on meta-analysis and therefore deviations in practice, while not incorrect, are significant for discussion. References:

References: 1. Fasting as a metabolic stress paradigm selectively amplifies cortisol secretory burst mass and delays the time of maximal nyctohemeral cortisol concentrations in healthy men. Bergendahl M, Vance ML, Iranmanesh A, Thorner MO, Veldhuis JD. J Clin Endocrinol Metab. 1996 Feb;81(2):692-9. PMID: 8636290 2. Female breakfast skippers display a disrupted cortisol rhythm and elevated blood pressure. Witbracht M, Keim NL, Forester S, Widaman A, Laugero K. Physiol Behav. 2015 Mar 1;140:215-21. http:// dx.doi.org/10.1016/j.physbeh.2014.12.044. Epub 2014 Dec 27. PMID: 25545767

POSTER 03 Most AAOMS Members Have Not Adopted the ASA Recommended NPO Guidelines R. E. Johnson III: Tufts University School of Dental Medicine, P. P. Eckert, W. C. Gilmore, A. Viswanath, M. Finkelman, M. Rosenberg The purpose of this study was to determine if AAOMS (American Association of Oral and Maxillofacial Surgeons) members have integrated the current American Society of Anesthesiologists (ASA) NPO Guidelines into their preoperative instructions. The investigators designed and implemented a crosssectional study and enrolled a random sample of US private practice AAOMS members. The predictor variables were year graduated from residency; dual-degree (MD and DDS/DMD) or single; and region. The primary outcome variable was adoption of ASA NPO Guidelines, defined as recommending fasting times of 2 hours for clear liquids and 6 hours for solid foods. To collect data, a systematic online search was implemented. Appropriate uni- and bivariate statistics were computed and the level of significance set at 0.05; 95% confidence intervals were also calculated. The study sample was composed of 431 (47.9%) clinicians. Almost all (99.1%) of the study sample did not adopt the ASA Guidelines. The fasting recommendations were different than 2 hours for clear liquids and 6 hours for solid foods. However, recommendations of 2 hours or greater for clear liquids were made by 99.8% and recommendations of 6 hours or greater for solid foods were made by 99.3% of OMS. Only 4.4% of OMS had different recommendations for clear liquids and solid foods. No significant association was found between whether OMS adopted the most current ASA Guidelines and year graduated from residency or dual-degree. OMS in private practice are overwhelmingly recommending longer fasting times for clear liquids and solid AAOMS  2016

1. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to ‘Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. Anesthesiology 3:114, 2011 2. Parameters of Care: Clinical Practice Guidelines for Oral and Maxillofacial Surgery (AAOMS ParCare 2012). Journal of Oral and Maxillofacial Surgery 11:70, 2012

POSTER 04 Submental Intubation in Maxillofacial Surgery R. N. Pauletti: Hospital Sao Vicente De Paulo De Passo , Fundo, J. A. Missel, P. Demori, A. Basualdo, L. C. CE A. Kuhn-Dall’Magro, N. L. Almeida, I. C. Bellenzier, I. F. Comunello Submental intubation was originally reported by Hernandez Altemir F in 1986. It presents undeniable advantages and near zero morbidity as in comparison to tracheostomy in facial trauma patients. This technique is as an alternative airway maneuver for maxillofacial procedures. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating maxillomandibular fixation. Indications for submental intubation are: Craniofacial traumatic injuries; Minimal neurologic deficit; Shortterm intraoperative intermaxillary fixation required to establish reduction and rigid fixation of fractures; Large pharyngeal flaps; And combined bimaxillary orthognathic surgeries and rhinoplasty cases. Its contraindications are: Patients with multisystem trauma; Long-term airway maintenance support required; Severe keloid previous knowledge; and severe neurological deficits. It provides a secure airway and no interference with maxillomandibular fixation or access to naso-orbito-ethmoid fractures. It avoids potential complications associated with nasotracheal intubation and tracheostomy in patients with multiple facial fractures, and obviates the need to alternate between oral and nasal intubation intraoperatively. Submental intubation is a safe, effective technique for many maxillofacial procedures, requiring the cooperation of both anesthesiologists and maxillofacial surgeons, and it can be used in cases of pan facial fractures, where it is not possible or when oral/nasotracheal intubation is contraindicated, and the tracheostomy, due to post operatory complications. Although this technique demands some surgical skill, the learning curve is not very steep and it is simple and easy to learn. No specialized equipment is needed which makes it even more acceptable. Since e-51