dictive hole technique allowed for ease of placement and excellent alignment of the bar and reconstruction, which would have oth- erwise been much more difficult to obtain through a transoral approach. Conclusions: The predictive hole technique is relatively simple and can be used by all Head and Neck Surgery departments. By using this technique, the surgeon can create his or her own custom plate without the added expense of a milled plate. SURGICAL REPAIR OF DOG BITES BASED ON ESTHETIC CONSIDERATIONS: UF JACKSONVILLE LEVEL I TRAUMA CENTER AND WOLFSON’S CHILDREN’S HOSPITAL EXPERIENCE. ANASTASIYA QUIMBY, CARLO GUEVARA, ASHLEY MANLOVE, PHILLIP PIRGOUSIS, BARRY STEINBERG UNIVERSITY OF FLORIDA HEALTH SCIENCE CENTER JACK- SONVILLE, JACKSONVILLE, FL, USA. Objective: Dog bite injuries remain one of the most common health care problems encountered each year. Historically, man- agement of the resulting wounds has been conservative with complex reconstructive efforts deferred because of concerns about infec- tion. The authors stipulate that strict adherence to the reconstructive ladder and delay of definitive repair of dog bite wounds in the head and neck area is not indicated on the basis of their experience with 103 patients who were treated at the level I trauma center at Uni- versity of Florida Health, Jacksonville, and Wolfson’s Children Hospital, Jacksonville. Study Design: A retrospective review of surgical logs and electronic patient charts from July 2008 to February 2016 was per- formed. In total, 148 patients were identified. Of those, 103 patients with 167 anatomic areas were included in the study. Patient de- mographic characteristics, area of dog bite, type of surgical repair, type of anesthesia provided, follow-up, and complications were re- corded. The dog bite areas were classified on the basis of aesthetic facial units. Type of surgical repair was categorized in accor- dance with the reconstructive ladder. Results: In the subject population, 66 (64%) were males and 37 (36%) were females, who had 167 anatomic areas involved, re- quiring a total of 168 types of repairs. Patient age ranged from 6 months to 69 years (mean age 17.6 years). Patients age less than 18 years comprised 66% of the study cohort. A total of 37 (22.2%) subunits required nonprimary repair, with the cheek (11), upper lip (6), and nose (6) being the most frequently involved sites; 130 (77.8%) subunits were repaired primarily, with the cheek (29), upper lip (22), and lower eyelid (15) being the most common sites. In total, there were 5 (3%) subunits with infection complications—2 (5.4%) in the nonprimary repair group and 3 (2.3%) in the primary repair group. Conclusions: Although reported widely in the literature, the rate of infection, requiring routine antibiotic prophylaxis, is minimal. The incidence of infection in this group was 4.8% of patients, and all infections resolved with an additional course of outpatient an- tibiotic treatment. We believe that delaying or avoiding an aesthetically more pleasing but complex type of repair because of fear of infection is unwarranted. Subsequently, we advocate the use of more complex approaches as the initial step if superior aes- thetic and functional results are expected, as opposed to following the routine reconstructive ladder algorithm. EFFECTS OF CANNABIS USE ON PATIENTS UNDERGOING OFFICE-BASED ANESTHE- SIA: A BRIEF LITERATURE REVIEW AND CASE REPORT OF 50 OUTPATIENT CASES OF IV SEDATION IN MAR- IJUANA USERS. NICHOLAS MECHAS, PAUL DEITRICK, ALLEN FIELDING TEMPLE UNIVERSITY, PHILADELPHIA, PA, USA. Objective: The widespread use of cannabis, including le- galization of recreational use in several states, can present problems to the health care practitioner when providing office-based anes- thesia. Marijuana is known to have profound effects on the cardiovascular, respiratory, neurocognitive, and autonomic nervous systems. Cardiovascular effects may manifest as tachycardia and increased systolic and diastolic blood pressures as well as possi- ble electrocardiographic changes. Respiratory system effects occur with frequent use of cannabis and include predisposition to bron- chospasm, chronic cough, and bronchitis. The physiologic effects of marijuana and its concomitant effects on sedation, as well as the subsequent impairment and the ability to sign informed consent, also need to be considered. The purpose of this study was to review 50 cases of patients undergoing office-based anesthesia with a history significant for marijuana use and to evaluate for preoperative, in- traoperative, and postoperative differences to determine the most effective way to consistently achieve adequate and safe sedation in this population. Study Design: Before reviewing the 50 cases, a literature review was conducted by using PubMed and Cochrane reviews of marijuana and its effects within health care and surgical settings. First, looking at the physiologic and metabolic effects laid the groundwork for determining how marijuana could play a role in the operative setting. Second, the impairment effect marijuana with regard to informed consent for elective procedures was investi- gated. Finally, the literature was reviewed with the intent of examining the effects of marijuana use on sedation and general anesthesia. Once the literature review was completed, we per- formed a retrospective analysis of 50 heavy marijuana users undergoing IV sedation in our clinic and the differences among their pre-, peri-, and postoperative courses. Impairment (last time from most recent consumption) and signing of informed consent, preoperative workup (auscultation, vitals monitoring), anesthesia requirements (drugs given and amount), course of sedation (com- plications), and postoperative recovery were evaluated. Results: From our retrospective analysis, 3 cases were ex- cluded because of the patient having consumed marijuana within a few hours before surgery leading to inability to consent. A single case was excluded because of inverted T waves on electrocardi- ography preoperatively. Twenty-six cases required preoperative albuterol to maximize airway patency and clearness to ausculta- tion or for concomitant asthma. Thirty-one cases were given glycopyrrolate to prevent increased secretions and possible se- quelae (laryngospasm, bronchospasm, aspiration). Use of diazepam, rather than midazolam, led to improved sedation experience and lowered intraoperative use of other medications, such as fen- tanyl, propofol, and ketamine. Postoperatively, quicker emergence from sedation was observed, as was less nausea and vomiting. No major complications occurred, although 1 patient was given phen- ylephrine for hypotension, and 1 was given flumazenil to treat delayed recovery. Conclusions: Increasing use of marijuana, both recreationally and medically, can complicate surgical treatment from the view- point of anesthesia and sedation. In the preoperative period, with regard to informed consent, elective surgical procedures should OOOO ABSTRACTS Volume 126, Number 5 Boukheir et al. e241