Airway and respiratory complications in children undergoing cleft lip and palate repair

I Desalu,Wl Adeyemo,Aa Adepoju,Mo Akintimoye

doi:10.4314/gmj.v44i1.68851

Abstract

Anatomical abnormalities associated with cleft lip and palate increase the risk of airway complications. The aim of this study was to determine the incidence of intra-operative airway and respiratory complications during cleft lip and palate repair and identify risk factors. Observational study in which fifty consecutive patients undergoing cleft lip or/ and palate repair (CL, CP, CLP) were prospectively studied in a teaching hospital in Nigeria. Anaesthesia was achieved by the inhalational or intravenous route. Tracheal intubation was performed under deep inhalational anaesthesia or muscle relaxation. All patients were ventilated. Demographic data, airway and respiratory complications were documented. The mean age of the patients was 26.62± 4.71(SEM) months (median 11.50). Nineteen airway complications occurred in 16 patients (incidence - 38%) as failed and difficult intubation (2% respectively) which only occurred in CP surgeries, Tube disconnection (6%), Tube compression (2%), Accidental extubation (2%) and Desaturation (14%). Laryngeal spasm (6%) and Bronchospasm (4%) occurred in surgeries for CP repair only. Some patients had more than one complication. Complications occurred in 38.4% of patients having CP repair, 15.8% having CL repair and 50% having CLP repair (p=0.185). This was not influenced by weight nor age group (p = 0.076 and 0.400 respectively). Cleft repair had a high incidence of airway/ respiratory complications. More complications occurred with CP surgery. There is a need to ensure adequately skilled personnel and appropriate monitoring to minimise morbidity.

Highlights

Children especially infants have a higher incidence of anaesthetic related complications.[1,2]. Due to their peculiar paediatric airway, they are prone to difficult airway management and laryngoscopy as well as other airway complications
Bordet[3] demonstrated that airway complications occurred in 7.87% of children under anaesthesia and that the incidence varied with the type of airway device used with laryngeal mask airway(LMA) having the highest incidence of 10.2%, tracheal tube 7.4% and facemask 4.7%
The risk of perioperative respiratory adverse effects is less if tracheal intubation is facilitated by muscle relaxants[8,9] and accidental extubation when positioning the head for surgery is minimised if the tube is placed 1.5 cm above the carina.[10]

Summary

Introduction

Children especially infants have a higher incidence of anaesthetic related complications.[1,2] Due to their peculiar paediatric airway, they are prone to difficult airway management and laryngoscopy as well as other airway complications. The difficulty in laryngoscopy and intubation seen in cleft palate patients is related to age, being higher in infants.[4] The risk of perioperative respiratory adverse effects is less if tracheal intubation is facilitated by muscle relaxants[8,9] and accidental extubation when positioning the head for surgery is minimised if the tube is placed 1.5 cm above the carina.[10]

Objectives

Methods

Results

Conclusion