Peri operative airway and respiratory complications in children undergoing cleft lip and palate repair at a tertiary institute: An observational study

Abstract

Introduction: Airway related problems have always been a major concern in paediatric patients more so in patients presenting with cleft lip/palate. Objective: Our aim was to determine the incidence of various types of perioperative airway and respiratory complications in children undergoing cleft lip and palate repair and their management at our tertiary care centre. Methodology: This prospective observational study was conducted over a period of 18 months in 50 ASA I and II paediatric patients (age group new born to 12 years) undergoing cleft lip/palate surgery. Complications during induction, intubation and postoperative period were noted. Results: Difficult laryngoscopy in 10% (n=5) patients & difficult intubation in 4% (n=2) patients were noted. No incidences of failed intubation were seen. Tube disconnection (n=1) and tube repositioning (n=2) after mouth gag placement. Desaturation occurred in 4% (n=2) patients, one during difficult intubation and one after mouth gag placement. One patient had laryngospasm during intubation. One patient had an episode of post extubation breath holding spell. One patient had tongue fall postoperatively. Conclusion: Airway and respiratory complications can be encountered during cleft lip and palate surgeries. Preoperative assessment and identifying any airway problems, congenital anomalies and comorbid conditions is important. Adequate preparation for difficult airway should be done before induction of anaesthesia to avoid morbidity and mortality. Intraoperative airway complications due to the shared airway have to be anticipated. Postoperative airway obstruction may be encountered and has to be treated prophylactically.