Cleft palate repair : Colligative - Practical Wisdom in Anesthesia, Surgery, and Medicine.

Sep 06, 2012

Consider the presence of other embryological abnormalities such as congenital heart disease, gastrointestinal atresia, and limb defects. refl.in/dg refl.in/df

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Sep 30, 2011

Complications, Contraindications

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Assessment, Workup

Chronic rhinorrhoea is common in children with cleft lip or palate due to food reflux into the nasal passages and they may frequently present with recurrent URTIs.
Repair of the cleft will reduce the fequency of URTIs and the risks of respiratory complications should be weighed against the benefits. refl.in/jv

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Sep 04, 2012

Preoperative Optimisation

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Consent, Discussion

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Coordinating

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Medication management, Premed

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Equipment, Preparation

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Duration

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Anatomy

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IV access

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Monitoring

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Special drugs

Dexamethasone 0.4mg/kg to minimise airway swelling.

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May 18, 2015

Antibiotics as per surgeons

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Oct 01, 2011

Muscle relaxation may be required to minimise muscle tone around the palate.

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May 18, 2015

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Airway, Ventilation

A nasopharyngeal airway (try to avoid oropharyngeal airways in palate repairs) inserted prior to extubation and kept in for a period of up to 24hrs may help maintain a patent upper airway until swelling subsides and the patient starts breathing through their mouth. refl.in/jv

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Sep 10, 2012

If the patient has a tracheostomy (eg Treacher Collins Syndrome) consider replacing the tracheostomy with a securely taped reinforced endotracheal tube.

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Mar 05, 2012

In patients with no associated congenital syndromes, difficult laryngoscopy and intubation has been associated with retrognathia and bilateral cleft lip (due to the protruding maxilla) refl.in/jv

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Sep 30, 2011

In the presence of large alveolar defects, there is a tendency for the laryngoscope to fall into the cleft, making laryngoscopy difficult. Packing with gauze may help prevent this, as may the use of a straight blade. refl.in/jv

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Sep 10, 2012

Insert a throat pack if a general anesthesic technique is used to protect the airway from blood and secretions refl.in/jv

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Oct 01, 2011

Nasal intubation is acceptable, except in those with history of pharyngoplasty, when it should be avoided where possible to prevent damage to the pevious repair. refl.in/jv

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(1 comment)

Sep 10, 2012

Not usually suitable for hard palate repairs as it will be in the way.

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Shared airway. Vigilance is required to prevent inadvertant extubation, kinking of the endotracheal tube, and endobronchial intubation. refl.in/jv

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Oct 01, 2011

The overall incidence of postoperative airway obstruction after cleft palate repair is approximately 6% in all patients. In children with congenital abnormalities of any type, the incidence rises to. refl.in/ju

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Sep 30, 2011

Positioning, Surgical access

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Procedure technique

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Anesthesia, Analgesia, Antiemesis

Clonidine may help provide sedation and minimise agitation and crying in recovery which may help to reduce bleeding postoperatively.

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(1 comment)

Dec 29, 2012

1.5mcg/kg #EN #RCH

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Placement of the Dingman gag (similar to a Boyle Davis-gag) will be stimulating. Opiate analgesia will help to blunt the tachycardia and hypertension.

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(1 comment)

Nov 16, 2012

Eg 5mcg/kg fentanyl

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Surgeon may want a local anaesthetic solution with 1:100,000 adrenaline.

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May 17, 2015