Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures

Abstract

The peri-operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8-year-period was studied. A marked increase in the extent of intra-operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra-opera tive blood transfusion. Post-operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not signhcantly reduce the operative blood loss. A post-operative pyrexial illness was significantly associated with the presence of a positive pre-operative nasal and throat swab and this could be significantly reduced by pre-operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine perioperatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post-operative pyrexia which could however be significantly reduced by the use of pre-operative antibiotics.

Anesthetic Management of Labial and Palatin Slots during a Humanitarian Mission at Matlaboul Fawzaini Hospital of Touba

“…We did not find any intraoperative or postoperative complications, certainly related to the absence of other associated malformation in our patients and a higher median age. In this regard, the frequencies found in the literature are very different but with a predominance of respiratory complications [3,6,8,9]. In contrast to fairly painless surgery for cleft lips, the surgery for cleft palates is very painful [8,10].…”

“…In this regard, the frequencies found in the literature are very different but with a predominance of respiratory complications [3,6,8,9]. In contrast to fairly painless surgery for cleft lips, the surgery for cleft palates is very painful [8,10]. Most authors prefer to use morphine or agonists for postoperative analgesia [3,6].…”

Anästhesiologisches Management bei Korrekturen von Lippen-Kiefer-Gaumenspalten bei Kindern

“…Doy le u. Hud son konn ten in ei nem Kol lek tiv von 194 Pa tien ten mit ei ner LKG bei 17 der Pa ti en ten gleich zei tig eine Pierre-Ro bin-Se quenz nach wei sen [27].…”

“…Hier zu zäh len un ter an de rem das de-Lange-Syn drom und der Gol den har-Sym ptomen kom plex. die post ope ra ti ven Kom pli ka tio nen [27,90,91]. Es lie gen heu te kon trol lier te prospek ti ve Un ter su chun gen über den Ein satz von gut steu er ba ren und in der Kin der anäs the sie be währ ten Me di ka men ten bei der Ope ra ti on von LKG vor [79].…”

“…In ei ner Un ter su chung aus den 80er-Jah ren des letz ten Jahr hun derts an ei nem Kol lektiv von 194 Kin dern wur de eine in tra opera ti ve Blut trans fu si on bei 10 al ler Säug-lin ge, die eine Lip pen kor rek tur er hiel ten und bei 16,8 der Kin der mit Ope ra ti on ei ner Gau men spal te für not wen dig er achtet [27]. Dies ent spricht nicht den Er fahrun gen an un se rem Zent rum.…”