Characteristics and anesthetic management of patients presenting for cleft surgery

Abstract

Background: Anesthetic management during surgery for cleft repair can be challenging due to abnormal airway anatomy and preoperative medical conditions. We sought to determine the characteristics, type, and incidence of associated medical problems, airway and other intraoperative complications in patients who presented to our facility for cleft lip and palate repair. Methodology: Fifty-six consecutive patients aged 16 years and below who had surgical repair of cleft lip or palate under general anesthesia during the study period were involved in this prospective, observational study. Routine preoperative review and anesthetic management were not altered. Preoperative medical and airway problems, associated congenital anomalies, intubation outcomes, intraoperative anesthetic complications, and postoperative airway problems were recorded by a blinded observer. Results: Forty-eight (72.7%) and 18 (27.3%) of the 56 patients had cleft lip and palate repair, respectively. Baseline packed cell volume was not significantly different. The incidence of upper respiratory tract infections (URTIs) and anemia were 33% and 0%, respectively, in the cleft palate repair group compared to 18.8% and 16.7% in the cleft lip repair group. Difficult laryngoscopy was found in 4.2% and 11.1% of patients that presented for cleft lip and palate repairs, respectively, and the overall incidence of desaturation was 7.5%. The mean blood loss was more in the cleft palate group compared to that of the cleft lip repair group (33.33 ± 37.73 versus 7.92 ± 6.51, P = 0.001). Conclusions: Cleft lip repair was most common in our review, and URTI was the predominant comorbidity in both groups. The risk of a wide range of perioperative airway complications necessitates the presence of skilled manpower during general anesthesia for cleft lip and palate surgery.