Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 57 (6), 562-8

Perioperative Respiratory Complications in Cleft Lip and Palate Repairs: An Audit of 1000 Cases Under 'Smile Train Project'

Affiliations

Perioperative Respiratory Complications in Cleft Lip and Palate Repairs: An Audit of 1000 Cases Under 'Smile Train Project'

Kalpana R Kulkarni et al. Indian J Anaesth.

Abstract

Background and aim: Anaesthesia for cleft surgery in children is associated with a variety of airway related problems. This study aims to review the frequency of associated anomalies and other conditions as well as perioperative respiratory complications during the cleft lip/palate repair surgeries.

Methods: An audit of 1000 cleft surgeries in children enrolled under "Smile Train" is presented. Following informed consent, general anaesthesia was induced with endotracheal (ET) intubation using halothane in O2 and/or intravenous thiopentone 5 mg/kg or propofol 1.5 mg/kg, suxamethonium 1.5 mg/kg or rocuronium 0.8 mg/kg and maintained with halothane/isoflurane 0.4-1% in 50% N2O in O2 with rocuronium. The observational data regarding the occurrence of perioperative complications in 1000 cleft surgeries are mentioned as mean (standard deviation), number and percentage as appropriate. 'Two sample t-test between percentage' is applied for significance.

Results: The frequency of isolated cleft lip was 263 (36.4%), cleft palate 183 (25.3%) and combined defect 277 (38.3%) of the operated cases. Other congenital anomalies were present in 21 (2.8%) of the children. The intraoperative airway complications occurred in 13 (2.4%) of cleft lip and 40 (8.7%) of cleft palate repairs (P < 0.05). Post-operative respiratory complications were observed in 9 (1.7%) and 34 (7.4%) patients of cleft lip and palate repairs respectively (P < 0.05). Mortality occurred post-operatively in 2 (0.2%) of cleft repairs (n = 1000).

Conclusion: Cleft deformities in children when associated with other congenital anomalies or respiratory problems pre-dispose them to difficult airway and pulmonary complications. Frequency of perioperative respiratory complications were significantly higher with cleft palate repair than with cleft lip repair. Anaesthetic expertise, optimum monitoring facility and specialised post-operative care is necessary to decrease the morbidity.

Keywords: Anaesthesia; cleft deformities; respiratory complications.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Associated congenital defects (PR syndrome: Pierre robin syndrome, SG stenosis: Subglottic stenosis, ASD: Atrial septal defect, VSD: Ventricular septal defect, PAD: Patent ductus arteriosus)
Figure 2
Figure 2
Frequency of intra-operative airway complications (T = 4.433, P 0.0000 < 0.05 [significant])

Similar articles

See all similar articles

Cited by 7 PubMed Central articles

See all "Cited by" articles

References

    1. Law RC, de Klerk C. Anesthesia for cleft lip and palate surgery. Updat Anesth. 2002;14:27–30.
    1. Sandberg DJ, Magee WP, Jr, Denk MJ. Neonatal cleft lip and cleft palate repair. AORN J. 2002;75:490–8. - PubMed
    1. 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. - PMC - PubMed
    1. 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. - PubMed
    1. Patient safety guidelines and recommendations. The smile train anaesthesia guidelines. 2005. [Last accessed on 2008 Mar 15]. Available from: http://www.medpro.smiletrain.org .
Feedback