Abstract
Background: Cleft lip and palate are one of the commonest congenital craniofacial anomalies. The aim of this study was to do a retrospective analysis of patients who underwent primary cleft surgeries.
Method: After approval from the institutional ethical committee retrospective analysis of 975 patients who underwent primary cleft lip, primary cleft palate and primary combined surgeries was done. The anaesthesia technique and complications were noted from the anaesthesia records. The data recorded was demographic profile, haemoglobin level, preexisting comorbidities, type of surgery and perioperative complications.
Result: The overall pre-existing morbidities, perioperative and post-operative complications were reported in 109 (11.2%), 117 (12%) and 52 (5.3%) participants respectively. In the pre-existing morbidities, Upper respiratory tract infection (URTI) was reported as the most common pre -existing morbidity (6.7%), various syndromes in 32 patients (3.3%). Congenital cardiac condition occurred in 1.2% In the perioperative complications, bronchospasm occurred in 4.1% most of these patients had URI and difficult intubation occurred in 3.3%. Post operatively 1.2% had bleeding and all of these patients had to be intubated postoperatively. It was noted that difficult intubation was more in cleft palate surgery 19 patients than cleft lip surgery 13 patients. Failed intubation occurred in equal number of patients in cleft lip and palate. Post-operative bleeding was also more in cleft palate surgery and post-operative bronchospasm occurred only in cleft palate surgeries
Conclusion: We observed URTI as the major preoperative challenge in addition to intra and post-operative complications. A thorough preoperative evaluation is imperative.
Keywords: Anesthesia; Cleft lip and palate; Endotracheal Intubation; Pierre Robin; Respiratory tract infection; Anaemia.
References
- Law RC, de Klerk C. Anesthesia for cleft lip and palate surgery. Update Anesth. 2002;14:27–30.
- Desalu I, Adeyemo W, Akintimoye M, Adepoju A. Airway and respiratory complications in children undergoing cleft lip and palate repair. Ghana Med J. 2010;44:16–20.
- Takemura H, Yasumoto K, Toi T, Hosoyamada A. Correlation of cleft type with incidence of perioperative respiratory complications in infants with cleft lip and palate. Paediatr Anaesth. 2002;12:585–8.
- Kotur PF. Surgical repair of cleft lip and palate in children with upper respiratory tract infection. Indian J Anaesth. 2006; 50:58–9.
- Kalpana R Kulkarni, Mohan R Patil, Abasaheb M Shirke, Shivaji B Jadhav. Perioperative respiratory complications in cleft lip and palate repairs: An audit of 1000 cases under ‘Smile Train Project’Indian J Anaesth. 2013;562-568
- Isabelle Arteau-Gauthier, Jacques E Leclerc, Audrey Godbout. Can We Predict a Difficult Intubation in Cleft Lip/Palate Patients?Journal of otolaryngology - head & neck surgery October 201140(5):413-9
- Bolton P. Anesthesia for cleft palate surgery. Anesthesia Intensive Care 2006;7:5.
- Mullik P, Talwar V, Gogia AR. The laryngeal mask-an aid for difficult intubation in a child with Pierre-Robin syndrome. Indian J Anaesth. 2005;49:51–3.
- 9 Murat I, Constant I, Maud'Huy H. Perioperative anaesthetic morbidity in children: a database of 24 165 anaesthetics over a 30-month period. Pediatr Anesth. 2004;14:158–166.
- Fillies T, Homann C, Meyer U, Reich A, Joos U, Werkmeister R. Perioperative complications in infant cleft repair. Head Face Med. 2007;3:9.
- McQueen KA, Magee W, Crabtree T, Romano C, Burkle FM.Jr Application of outcome measures in international humanitarian aid: Comparing indices through retrospective analysis of corrective surgical care cases. Prehosp Disaster Med. 2009;24:39–46.
- Antony AK, Sloan GM. Airway obstruction following palatoplasty: Analysis of 247 consecutive operations. Cleft Palate Craniofac J. 2002;39:145–8.
- Mukozawa M, Kono T, Fujiwara S, Takakura K. Late onset tongue edema after palatoplasty. Acta Anaesthesiol Taiwan. 2011; 49:29–31.
- Quershi FA, Ullah T, Kamran M, Illyas M, Laiq N. Anesthetist experience for cleft lip and cleft palate repair: A review of 172 smile train sponsored patients at Hayat Abad medical complex, Peshawar. JPMI. 2009;23:90–4.
Corresponding Author
Chadha Meenu MD
Consultant & Pain Physician, Head, Department of Anesthesiology, CHL Hospitals, AB Road, LIG Square, Indore (M.P.) India