Abstract
The most common craniofacial anomalies in children are cleft lip and palate with an incidence of 1:800 live births. Associated anomalies are common in patients with both cleft lip and palate (28%). Most commonly these anomalies affect the vertebral column or limb (33%) and the cardiovascular system (24%). Almost 150 syndromes are associated with cleft deformities and well known are Pierre Robin’s, Goldenhar, and Treacher Collins syndrome. On an average, 5–10% of these patients have congenital heart disease (CHD) such as ventricular septal defect, atrial septal defect, and cyanotic CHD. Until now, there are no clear guidelines regarding the timing of cleft surgery, especially if the child is having airway problems. In this article, we report an unusual case of a 6-month-old female child with weight of 6.5 kg with no medical history, who underwent surgical repair of congenital cleft lip in general anesthesia, leading to sudden collapse.
Highlights
Cleft lip and palate are the defects of birth caused by the disorder of anatomical and genetical factors [1]
Especially in cleft patients, airway-related problems account for majority of anesthetic morbidity and mortality
Pre-operative evaluation Children with cleft deformities are usually associated with hearing defects, upper respiratory tract, and ear infections and have poor nutrition and anemia
Summary
Cleft lip and palate are the defects of birth caused by the disorder of anatomical and genetical factors [1]. Chest X-ray and pediatrician consent for surgery under general anesthesia were obtained before surgery. Pre-operative fasting was observed for 4 h for milk and 2 h for clear fluids Baseline vital parameters such as heart rate, non-invasive blood pressure, electrocardiogram, and peripheral capillary oxygen saturation (SpO2) were noted inside the operation theater. The baby was started with normal saline bolus, given IV fluid antibiotics and other supportive measures. Initial chest X-ray showed the left lung collapse which can be shown in Fig. 2 with ET tube placed low down toward the right main bronchus which was pulled back and repositioned. Repeat chest X-ray showed good expansion of the left lung (Fig. 3). The baby gradually improved with treatment and sensorium improved, and the infant was extubated after 2 days and put on oxygen with nasal prongs. The baby was hemodynamically stable after 3 days at the time of discharge
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