Head and neck reconstructive surgery involving tissue flaps is often complex requiring the development of an individualized anesthetic plan. The following case report describes the anesthetic management of an 87-year-old man considered at high risk for postoperative delirium due to advanced age and blindness undergoing general anesthesia for resection of squamous cell carcinoma of the right side of the nose and reconstructive surgery with a scalping forehead flap. Ultrasound-guided local anesthetic maxillary and supraorbital nerve blocks were successfully used perioperatively to reduce the need for alternative analgesics associated with higher risks of complications such as postoperative nausea, vomiting, and delirium.
Keywords: General anesthesia; Geriatric anesthesia; Perioperative analgesia; Postoperative delirium; Scalping forehead flap; Supraorbital nerve block; Ultrasound-guided maxillary nerve block.
© 2020 by the American Dental Society of Anesthesiology.