Perioperative adverse airway events in cleft lip and palate repair

Abstract

Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate patients. Method: This was a prospective cohort study conducted in a tertiary hospital in a suburban south-western Nigerian town. One hundred and sixteen patients who had cleft lip and palate repair over a five-year period were included. The demographic data, surgical diagnosis, congenital anomalies, procedures performed, medical problems, perioperative anaesthetic and surgical complications were studied. Results: Adverse airway events were observed in six patients (4.6%). These included postoperative chest infection (n=2), failed intubation (n=1), difficult intubation (n=1), post-extubation bronchospasm (n=1), and laryngeal oedema (n=1). All, except one, who developed complications were patients with combined cleft lip and palate. No mortality was recorded. Conclusion: Adverse perioperative airway events in cleft lip and palate surgery are common and are more likely to be associated with combined cleft lip and palate than with isolated lip or palate defects. These complications usually occur immediately following extubation or in the early postoperative period. The severity may necessitate intensive care unit admission and specialised care.