Patients requiring oral surgery may need specific nursing considerations prior to, during and in the recovery period of anaesthesia. The range of patients encountered may be wide, from young healthy animals to the elderly and compromised patient. With any patient undergoing anaesthesia an understanding of the animal's history, any preexisting conditions and expectations for surgery will allow correct preparation for the procedure. By pre-empting problems that could affect the patient's anaesthesia, such as difficult intubation, reduced patient access, or suspected blood loss, complications may be avoided.

Prior to induction of anaesthesia the patient should have a full clinical examination. Diagnostic tests such as blood profiles and radiography may be performed to identify any conditions that may influence anaesthesia such as azotaemia or megaoesophagus. Many patients presented for dental-related oral surgery may be elderly. Geriatric patients will have an age-related reduction in organ function and their ability to compensate for the requirements of anaesthesia will be reduced. Intravenous fluid therapy may be required to provide circulatory support. Respiratory depression due to the use of sedative and anaesthetic agents should be supported and blood pressure measurement should be monitored to ensure there is adequate perfusion to the major organs. Brachycephalic patients should be pre-oxygenated for 5 minutes with flow-by or mask oxygen in case difficulty occurs during intubation. A wide range of sizes of endotracheal tube should be available as these breeds often have small airways in relation to the size of patient. Intravenous fluid therapy will be indicated in patients that have been unable to eat due to oral disease or trauma; these patients must be stabilised prior to anaesthesia and nutritional support must be addressed early in the patient's treatment to aid recovery.

Vascular access in patients undergoing general anaesthesia should be mandatory. The placement of a hindlimb catheter will often allow easier access during anaesthesia than a catheter placed into a cephalic vein. Inaccessibility to the patient due to positioning and surgical draping can lead to potential problems so monitoring of vital parameters during anaesthesia may have to be adapted. Pulse oximeters may not be able to be placed upon the tongue due to it being in the surgical field. Even when not in the surgical field, consideration must be given to whether it will be possible to reposition the probe should it become necessary. Alternative sites such as the pinna, digit, vulva or prepuce may all allow reliable readings.

Disconnection of the anaesthetic circuit can go undetected when covered by surgical drapes, and careful attention must be given to securing any connections that could become disconnected. Anaesthetic circuit drag upon the endotracheal tube should be prevented by securing the circuit to the operating table. Capnography and apnoea detectors are useful in allowing prompt detection should disconnection occur; monitoring of chest and rebreathing bag movement simultaneously must be closely observed. Anaesthesia circuits with pressure-relief valves at the patient end are best avoided to reduce circuit drag and bulk.

Endotracheal tubes should be checked prior to use to ensure that cuffs are intact, correct inflation of the cuff should be checked at induction by an assistant listening for leakage around the tube whilst gentle positive pressure ventilation is given to the patient. Occlusion of the endotracheal tube by flexion of the neck during positioning must be avoided and an armoured tube may be required if extreme patient positioning is necessary. Additional pharyngeal packing may be needed to prevent fluids or debris from entering the trachea; gauze swabs, lengths of bandage and absorbent sponges can all be used. It is advisable to only use swabs and sponges that have 'tails' attached to them as this allows them to be tied together or secured to the endotracheal tube to ensure they are all removed. A foolproof method of ensuring that any packing is removed prior to extubation must be implemented.

Difficult intubation may be encountered in some patients where opening of the jaw is limited due to conditions such as unstable fractures, dislocations and neoplasia. Anaesthesia is maintained with incremental doses of injectable agents and supplementary flow-by oxygen until gaseous anaesthesia can be implemented. Placement of a narrow stylet into the trachea may be possible which can then allow a larger endotracheal tube to be advanced over the stylet. In situations where oral intubation methods are prevented, a temporary tracheotomy may be performed to gain a secure airway; this approach may also be used when conventional intubation obstructs the surgical site. Pharyngotomy-placed endotracheal tubes also allow complete access to the oral cavity and are advantageous when excessive manipulation of the jaw is required. Temporary closure of the jaw by a suture may be performed in cats to treat jaw fractures and intubation via a pharyngotomy approach allows a secure airway to be maintained until recovery. The endotracheal tube is removed when the patient has a good level of consciousness, and the pharyngotomy site is left to heal or closing sutures may be placed.

Hypothermia during anaesthesia and recovery must be prevented or corrected to avoid complications such as delayed drug metabolism, arrhythmias and hypoventilation.

Procedures such as maxillectomy, mandibulectomy and glossectomy can result in extensive blood loss; non-invasive or ideally invasive blood pressure monitoring should be used. The amount of blood loss must be closely monitored by the measurement of suction bottle contents and weighing of swabs; intravenous fluid therapy of crystalloids and colloids can be used to maintain circulating volume. With procedures where blood loss is anticipated, autologous transfusions can be planned. A unit of blood or the estimated amount of loss is collected up to a week prior to surgery and stored; it is then autotransfused to the patient on the day of surgery.

At the end of surgery all pharyngeal packing is removed and the mouth and pharynx cleaned of any blood or debris that could be inhaled at extubation. Patients must be monitored closely in the postoperative period for signs of swelling or bleeding that could cause respiratory obstruction.