Anaesthesia for Cleft Lip and Palate Surgery: Study from a Hospital of Eastern Nepal

Abstract

IntroductionCleft lip and palate deformity is the most common congenital birth defect caused by complex genetic and environmental factors. Pre-operative management of these patients is always challenging and anesthesia has a great role for the surgery.ObjectiveThe aim of this study is to evaluate the outcomes including pre-operative election of cases, intra-operative and post-operative complications in pediatric patients.MethodologyThis is retrospective study conducted on cleft lip and palate repair patients between the ages of 3 months to 12 years, operated under general anesthesia during last six years at Morang Co-operative Hospital, Biratnagar, Nepal. Total 570 patients were assessed with preoperative, intra-operative and post-operative parameters, complications and managements. The MS Excel office and SPSS software was used to analyze the data.ResultsAmong 570 patients about one third came from the high mountain and hilly region and the rest from the Tarai. The maximum travel _me to reach the hospital was 2 days. The percentage of cancellation was 22.13% and was mainly due to the respiratory problems. Among 570 patients 352(61.75%) were males. While classifying the cases, 202 cases were presented with only cleft lip, 325 cleft lip and palate combined and 43 patients with isolated cleft palate. Narcotics were not used for analgesia and analgesia maintained with other measures. There was no intra and post-operative death and none of the patient received intra-operative blood transfusion.ConclusionCleft lip and palate surgery in pediatric patients is possible in any hospitals when trained man power and proper operating and post-operative setup is available. Anesthesia for cleft lip and palate is challenging associated with several complications requiring continuous and vigilant anesthetic supervision and management for the better outcome.Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 127-133

Anesthesia Considerations in the Perioperative of Patients with Lip and Palate Length

“…In the different bibliographic reviews, there is no consensus on an ideal anesthetic technique or with more preference; the choice will be made based on the characteristics and needs of each patient. There are reports of balanced general anesthesia without neuromuscular relaxation, balanced general anesthesia with neuromuscular relaxation, and intravenous total anesthesia with and without neuromuscular relaxation without significant differences between them [11,20].…”

“…The nerve branches involved depend on the type and location of the defect [10] a. Infiltration of local anesthetic at the surgical site. The use of long-acting bupivacaine-type AL calculated per kilogram of weight is suggested and consider the possible margin distortion when injected [11,29].…”

“…The etiology is heterogeneous due to the interaction of genetic and environmental factors during the early stages of pregnancy such as exposure to tobacco, alcohol consumption, nutritional deficiencies, viral infections, and exposure to phenytoinlike teratogens, valproic acid, thalidomide, and herbicides [8,11]. Prenatal diagnosis of cleft lip can be performed reliably in the 18-20 weeks of gestation, while the cleft palate is difficult to identify before birth [10].…”