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Optimizing Perioperative Anesthesia Protocols for Global Delivery of Safe Cleft Surgery
Vamsi C Mohan1,2, Winston R Owens1,2, Zipporah Gathuya3
1From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine.
Plastic and Reconstructive Surgery
|September 25, 2025
Summary
Optimizing perioperative anesthetic management for cleft lip and/or palate (CL/P) patients involves careful preoperative nutrition, intraoperative airway control, and postoperative pain and feeding strategies for improved outcomes.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Cleft Care
Background:
- Cleft lip and/or palate (CL/P) repair necessitates specialized perioperative anesthetic management.
- Key considerations include preoperative nutrition, intraoperative airway management, and postoperative pain and feeding protocols.
Purpose of the Study:
- To highlight the critical aspects of perioperative anesthetic management for CL/P patients.
- To emphasize the importance of nutrition, fasting, airway, and pain management throughout the perioperative period.
Main Methods:
- Literature review and expert clinical experience in low- and middle-income countries.
- Focus on anesthetic care for patients with cleft lip and/or palate (CL/P).
Main Results:
- Comprehensive preoperative assessment is vital for identifying and managing comorbidities.
- Anesthesia providers play a crucial role in nutritional assessment, feeding protocols, pain management, and team communication.
- Patient optimization preoperatively and postoperatively is essential for favorable surgical outcomes.
Conclusions:
- Thorough preoperative evaluation, nutritional assessment, and optimized nil per os (NPO) protocols are required.
- Intraoperative management includes video laryngoscope-assisted intubation and throat pack use.
- Postoperative care emphasizes nonopioid pain management and early feeding resumption.
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