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Cleft lip and palate surgery in children: anaesthetic considerations
D Y Kwari1, J Y Chinda, H O Olasoji
1Department of Anaesthesia, University of Maiduguri Teaching Hospital, Maiduguri, Borno State, Nigeria. kwarydan@yahoo.com
Insights
Anesthesia for cleft lip and palate repair is safe in developing countries, though children undergoing general anesthesia face higher complication risks. Local anesthesia is recommended for adults and cooperative older children.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Craniofacial Surgery
Background:
- Cleft patient care presents significant challenges, particularly in developing nations with limited skilled personnel.
- Team-based cleft care is often unavailable in resource-limited settings.
- This study addresses anesthetic challenges in pediatric cleft management.
Purpose of the Study:
- To highlight the anesthetic challenges encountered in managing cleft lip and palate patients.
- To evaluate the safety and complications of different anesthetic techniques in cleft repair.
- To provide recommendations for optimal anesthesia strategies in team-based cleft care.
Main Methods:
- A retrospective study of 106 cleft lip and palate patients managed during team cleft care activities.
- Data collected from January to June 2009 at University of Maiduguri Teaching Hospital and Federal Medical Centre Nguru, Nigeria.
- Analysis of anesthetic techniques (general vs. local anesthesia) and associated complications.
Main Results:
- 106 patients underwent cleft repair; 15% were children unfit for general anesthesia.
- 86% of patients received either halothane general endotracheal anesthesia or local anesthesia.
- Local anesthesia had no complications; general anesthesia in children resulted in hypoxia, laryngospasm, and other issues in 15% of cases.
Conclusions:
- Anesthesia for cleft repair in team-based care settings is relatively safe.
- General anesthesia with controlled ventilation is recommended for children.
- Local anesthesia is advised for adults and older children capable of cooperation.
Background:
The Care of cleft patients is very challenging. Team cleft care is usually lacking in many developing countries due to shortage of qualified manpower. This study is aimed at highlighting anaesthetic challenges in the management of cleft in children.
Patients And Methods:
This was a study of cleft lip and palate patients who were managed during team cleft care activities at University of Maiduguri Teaching Hospital and Federal Medical Centre Nguru both in north eastern Nigeria from January to June 2009.
Results:
One hundred and six cleft patients presented for surgical repair under general or local anaesthesia. Fifteen (14%) patients all of whom children were unfit for general anaesthesia due to various medical reasons. Ninety-one (86%) cleft patients comprising 53(50%) children and 38(36%) adults had cleft repair under halothane general endotracheal anaesthesia and local anaesthesia, respectively. There was no anaesthetic complications recorded under local anaesthesia. Fifteen percent of children who received general endotracheal anaesthesia suffered various anaesthetic complications which included hypoxia (3.8%), laryngospasm (1.9%), kinking of endotracheal tube (5.7%), inadvertent extubation (1.9%) and pulmonary aspiration (1.9%). There was no mortality or anaesthesia-related morbidity at the time of discharge in all the cases.
Conclusion:
We conclude that anaesthesia for cleft lip and palate repair in hospital based team-cleft care activities in our environment is relatively safe. We recommend general anaesthesia with controlled ventilation for children and local anaesthesia for adult and older children who can cooperate.
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