A Single Center Anesthesia Experience in  Children Posted for Cleft Lip and Palate Repair:  A Retrospective Analysis from a Post-Anesthesia  Care Unit

Ali Muhittin Taşdoğan; Ebru Tarıkçı Kılıç

doi:10.5152/eurjther.2019.19053

Authors

Ali Muhittin Taşdoğan Department of Anesthesiology, Hasan Kalyoncu University School of Medicine, Gaziantep https://orcid.org/0000-0002-4017-9071
Ebru Tarıkçı Kılıç Clinic of Anesthesiology and Perioperative Medicine, Ümraniye Training and Research Hospital, İstanbul https://orcid.org/0000-0002-5377-1090

DOI:

https://doi.org/10.5152/eurjther.2019.19053

Keywords:

Anesthesia, cleft lip and palate repair, difficult airway, postoperative complications

Abstract

Objective: Cleft lip and palate (CLP) is one of the most commonly seen craniofacial abnormalities in children. Anesthesia management for these surgeries is challenging due to the emergence of airway problems and perioperative complications. In this study, we aimed to evaluate airway difficulties and perioperative anesthetic complications in children suffering from CLP.
Methods: After obtaining approval from the institutional review board, this retrospective study was conducted on 29 children that underwent CLP repair from January 2014 to December 2016 at a single center. Demographic parameters, patients with CLP, patients having micrognathia, associated syndromes, associated congenital abnormalities, difficult mask ventilation, difficult intubation, duration of anesthesia, number of intubated patients to be transferred to the post-anesthesia care unit (PACU), airway-associated complications, and intraoperative and postoperative complications were recorded.
Results: Data from a total of 29 patients with cleft palate were included. Out of the 29 patients, 15 patients had a cleft lip, 17 patients had micrognathia, and 10 patients had both cleft lip and micrognathia. Three patients had difficult mask ventilation, while seven had difficult intubation. Intubation failure was seen in three patients in whom a fiber optic laryngoscope was successfully utilized. Airway-associated complications were seen in six patients. Only three patients had postoperative complications. There were no mortalities.
Conclusion: CLP deformities in children with associated abnormalities are predisposed to difficult airway-associated and postoperative complications. Specialized perioperative care is necessary.

Metrics

Metrics Loading ...

References

Mahajan RK, Kaur A, Singh MS, Kumar P. A retrospective analysis of incidence and management of palatal fistula. Indian J Plast Surg 2018; 51: 298-305.

Kulkarni KR, Patil MR, Shirke AM, Jadhav SB. Perioperative respiratory complications in cleft lip and palate repairs: an audit of 1000 cases under Smile Train Project. Indian J Anaesth 2013; 57: 562-8.

Bordet F, Allaouchiche B, Lansiaux S, Combet S, Pouyau A, Taylor P et al. Risk factors for airway complications during general anesthesia in paediatric patients. Paediatr Anaest 2002; 12: 762-9.

Takemura H, Yasumoto K, Toi T, Hosoyamada A. Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate. Paediatr Anaesth 2002; 12: 585-8.

Patient safety guidelines and recommendations. The smile train anaesthesia guidelines. 2005. [Last accessed on 2008 Mar 15]. Available from: http://www.medpro.smiletrain.org.

Tiret L, Nivoche Y, Hatton F, Desmonts JM, Vourc’h G. Complications related to anaesthesia in infants and children. A prospective survey of 40240 anaesthetics. Br J Anaesth 1988; 61: 263-9.

Cohen MM, Cameron CB, Duncan PG. Pediatric anesthesia morbidity and mortality in the perioperative period. Anesth Analg 1990; 70: 160-7.

Jindal P, Khurana G, Dvivedi S, Sharma JP. Intra and postoperative outcome of adding clonidine to bupivacaine in infraorbital nerve block for young children undergoing cleft lip surgery. Saudi J Anaesth. 2011; 5: 289-94.

Fillies T, Homann C, Meyer U, Reich A, Joos U, Werkmeister R. Perioperative complications in infant cleft repair. Head Face Med 2007; 3: 9.

McQueen KA, Magee W, Crabtree T, Romano C, Burkle FM Jr. Application of outcome measures in international humanitarian aid: Comparing indices through retrospective analysis of corrective surgical care cases. Prehosp Disaster Med 2009; 24: 39-46.

Sen J, Sen B. Anesth Essays Res. Airway management: A comparative study in cleft lip and palate repair surgery in children. 2014; 8: 36-40.

Mukozawa M, Kono T, Fujiwara S, Takakura K. Late onset tongue edema after palatoplasty. Acta Anaesthesiol Taiwan 2011; 49: 29-31.

Raghavan U, Vijayadev V, Rao D, Ullas G. Postoperative management of cleft lip and palate surgery. Facial Plast Surg 2018; 34: 605-11.

Edomwonyi NP, Isah IJ, Obuekwe ON. Cleft lip and palate repair: Intraoperative and recovery room complications. Expe Pan African Anesthesia Symposium; 2008; Nairobi, Kenya.

Kwari DY, Chinda JY, Olasoji HO, Adeosum OO. Cleft lip and palate surgery in children: Anesthetic considerations. Afr J Paediatr Surg 2010; 7: 174-7.

Bunsangjaroen P, Thongrong C, Pannengpetch P, Somsaad S, Rojanapithayakorn N, Polsena L, et al. Anesthetic tecniques and perioperative complications of cleft lip and cleft palate surgery at Srinagarind Hospital. J Med Assoc Thai 2015; 98(Suppl 7): S158-63.

Sroyhin W, Thiamwisai L, Surit P, Chowchuen B. Evidence triggered for care of patients with cleft lip and palate in Srinagarind Hospital. J Med Assoc Thai 2016; 99(Suppl 5): S58-64.