A study of anaesthetic management of cleft lip and palate surgery in children

Introduction: Anaesthetic management in paediatric patient can present anatomically and physiologically challenges to the anaesthetics. Therefore, surgery of cleft lip and palate in children will require careful consideration and thorough knowledge and clinical application in preparation by the anaesthetics as they are not miniature version of adults. Objective: To evaluate the anaesthetic outcomes including pre-operative selection of cases, intra-operative and post-operative complications in children underwent cleft lip and palate surgery. Materials and Methods: 30 patients of cleft lip and/or cleft palate malformation scheduled for surgical repair under general anaesthesia at plastic surgery unit of tertiary care teaching hospital were selected for the study. All patients with age more than 3 months; weight more than 5 kg; no history of URTI / fever; normal chest x-ray; and leukocyte count less than 10000/cum, were included in the study. The patient's haemoglobin less than 10 gm% were excluded from the study. Results: A majority of patients (22, 73.33%) belonged to less than 3 years of age. Patients were divided in 2 groups with 15 patients in each group according to induction technique. Group I which was induced by inhalation technique with Oxygen, Nitrous Oxide and Halothane and group II which were induced by intravenous Ketamine and Succinylcholine. Intubation was difficult in one patient of Group II. Increased intratracheal secretion occurred in 2 patients of Group II. Laryngospasm was found in 1 case of group II and there was also vomiting in 1 case of group II. Conclusion: A favourable outcome can be expected in cleft lip and palate surgery in children by adequate understanding of the anatomy, physiology, and psychology of the paediatric patients; and proper selection and through pre-operative assessment and preparation.