Anaesthesia for cleft lip and palate surgery in children

Anaesthesia management for cleft lip in a child with unrepaired Tetralogy of Fallot in Malawi: a case report

“…Ketamine is a good agent of induction of patients with TOF to maintain balance between systemic vascular resistance (SVR) and PVR [5][6][7]11,14 . Considering an infraorbital nerve block in a multimodal analgesia strategy in these patients present several advantages including reducing inhalational anaesthetic requirement which may lower the SVR, fastening of emergence, reducing the need of opioids in addition to provide adequate perioperative pain control 1,2 . The child presented a hypercyanotic episode (tet spells) in recovery which responded well on administration of morphine, noradrenaline, fluid and oxygen.…”

“…Cardiac abnormalities are the most frequent associated comorbidity. Tetralogy of Fallot (TOF), atrial septal defect and ventricular septal defect represent the most common congenital heart diseases seen in this patient population 1,2 . Proper understanding of the cleft condition, the associated abnormalities and the surgery is the key element to administration of safe anaesthesia for cleft lip and palate and effective management of complications [1][2][3][4] .…”

“…Tetralogy of Fallot (TOF), atrial septal defect and ventricular septal defect represent the most common congenital heart diseases seen in this patient population 1,2 . Proper understanding of the cleft condition, the associated abnormalities and the surgery is the key element to administration of safe anaesthesia for cleft lip and palate and effective management of complications [1][2][3][4] . TOF is one of the commonest cyanotic congenital heart malformations and is characterised by four cardinal features: ventricular septal defect (VSD); right ventricular outflow tract obstruction (RVOTO), which has a fixed and a dynamic component in most patients; an overriding aorta; and RV hypertrophy (RVH).…”

Tranexamic acid – a useful drug in ENT surgery?

“…These actions inhibit the conversion of plasminogen to plasmin on the surface of the fibrin, producing stabilisation of fibrin clots. 13 Tranexamic acid mouthwashes used after oral surgery in patients taking anticoagulants (typically 1 g three times daily for 5 days) reduces the rate and volume of bleeding. 6 Tranexamic acid has been widely used parenterally in elective cardiac, orthopaedic and urological surgery to reduce peri-operative blood loss.…”