Anaesthesia for cleft lip surgery--challenge in rural Nepal

Cleft lip and palate is quite common in Nepalese population residing in hilly areas and interior of the country. Nepalese doctor with limited resources and fund and International aided team of fully equipped doctors from developed world conduct operative procedure in the centre or district hospital setup quite frequently. But very few patients will come to the hospital for treatment as it is not an emergency for them. Anaesthesia for cleft lip and palate surgery carries a high risk and difficulty in airway management. Associated congenital anomalies further complicate the management. Still a team of Nepalese physicians are providing this service in a field. How to provide a safe anaesthesia was a main concern for an anaesthesiologist with a limited supply. During the last three years we have anaesthetized safely four hundred children age between 2 months to 14 years. The team worked at an altitude ranging from 100 feet to 10,000 feet of Nepal in a temporary erected operation room of the village. Most of the operation was conducted under total Ketamine anaesthesia and general anaesthesia with halothane. In our context we found Ketamine anaesthesia was safe and effective anaesthetic technique in simple clefts in children more than 2 years. This technique reduces the cost by minimizing the supply to be carried in the field.