Lefort + Bilateral Sagittal Split (BSSO)

Last updated: February 9, 2026

Access
PIV x2
Airway
ETT Nasal RAE (Afrin, heat the ETT to mold it soft, lubricate with ultrasound lube)
Induction
Mask or IV
Maintenance
Propofol, Dexmedetomidine, paralytic. TIVA for smoother wakeup, but gas and paralysis can also be used
Emergence
Awake
Antibiotics
Ampicillin/Sulbactam
Position
Standard

Notes

tranexamic acid Bolus 10 mg/kg and tranexamic acid gtt (5-10 mg/kg/hr)