Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures

Abstract

SummaryThe peri‐operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8‐year‐period was studied. A marked increase in the extent of intra‐operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra‐operative blood transfusion. Post‐operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not significantly reduce the operative blood loss. A post‐operative pyrexial illness was significantly associated with the presence of a positive pre‐operative nasal and throat swab and this could be significantly reduced by pre‐operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine peri‐operatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post‐operative pyrexia which could however be significantly reduced by the use of pre‐operative antibiotics.