ACUTE BRADYCARDIA AND ATELECTASIS AFTER ENDOTRACHEAL INTUBATION IN CLEFT CHILD: A CASE REPORT AND REVIEW OF ANESTHESIA MANAGEMENT IN CLEFT LIP AND PALATE PATIENTS
The most common craniofacial anomalies in children are cleft lip and palate with an incidence of 1:800 live births. Associated anomalies are common in patients with both cleft lip and palate (28%). Most commonly these anomalies affect the vertebral column or limb (33%) and the cardiovascular system (24%). Almost 150 syndromes are associated with cleft deformities and well known are Pierre Robin’s, Goldenhar, and Treacher Collins syndrome. On an average, 5–10% of these patients have congenital heart disease (CHD) such as ventricular septal defect, atrial septal defect, and cyanotic CHD. Until now, there are no clear guidelines regarding the timing of cleft surgery, especially if the child is having airway problems. In this article, we report an unusual case of a 6-month-old female child with weight of 6.5 kg with no medical history, who underwent surgical repair of congenital cleft lip in general anesthesia, leading to sudden collapse.
2. Law RC, de Klerk C. Anaesthesia for Cleft and Palate Surgery. UK: Update in Anaesthesia; 2002.
3. Nargozian C. The airway in patients with craniofacial abnormalities. Paediatr Anaesth 2004;14:53-9.
4. Hatch DJ. Airway management in cleft lip and palate surgery. Br J Anaesth 1996;76:755-6.
5. Gunawardana RH, Gunasekara SW, Weerasinghe JU. Anesthesia and surgery in pediatric patients with low hemoglobin values. Indian J Pediatr 1999;66:523-6.
6. 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.
7. Todd NW, Holt PJ, Allen AT. Safety of neck rotation for ear surgery in children with down syndrome. Laryngoscope 2000;110:1442-5.
8. Gunawardana RH. Difficult laryngoscopy in cleft lip and palate surgery. Br J Anaesth 1996;76:757-9.
9. Gupta S, Sharma R, Jain D. Airway assessment: Predictors of difficult airway. Indian J Anaesth 2005;49:257-62.
10. Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984;39:1105-11.
11. Bosenberg AT, Madaree A, Osborn I, Bill P. Malignant hyperthermia associated with cleft palate, clubfoot and myopathy. Paediatr Anaesth 2002;12:92.
12. Xue FS, Zhang GH, Li P, Sun HT, Li CW, Liu KP, et al. The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate. Paediatr Anaesth 2006;16:283-9.
13. Mc Donald DS, McCormick A, Mackersie AM. Difficulty with a preformed tube in a neonate. Paediatr Anaesth 1997;7:87.
14. Doyle E, Hudson I. Anaesthesia for primary repair of cleft lip and palate: A review of 244 procedures. Paediatr Anaesth 1992;2:139-45.
15. Steinmetz J, Holm-Knudsen R, Sørensen MK, Eriksen K, Rasmussen LS. Hemodynamic differences between propofol-remifentanil and sevoflurane anesthesia for repair of cleft lip and palate in infants. Paediatr Anaesth 2007;17:32-7.
16. Bell C, Oh TH, Loeffler JR. Massive macroglossia and airway obstruction after cleft palate repair. Anesth Analg 1988;67:71-4.
17. Dell’Oste C, Savron F, Pelizzo G, Sarti A. Acute airway obstruction in an infant with pierre robin syndrome after palatoplasty. ActaAnaesthesiol Scand 2004;48:787-9.
18. Flemming DC, Cooperman LH. Complications in Anaesthesiology. 2nd ed. Philadelphia, PA: JB Lippincott Co.; 1983.
19. Szekely SM, Webb RK, Williamson JA, Russell WJ. The Australian incident monitoring study. Problems related to the endotracheal tube: An analysis of 2000 incident reports. Anaesth Intensive Care 1993;21:611-6.
20. Gaiser RR. Teaching airway management skills. How and what to learn and teach. Crit Care Clin 2000;16:515-25.
21. Henriksson TG, Skoog VT. Identification of children at high anaesthetic risk at the time of primary palatoplasty. Scand J Plast Reconstr Surg Hand Surg 2001;35:177-82.
22. Xue FS, An G, Tong SY, Liao X, Liu JH, Luo LK, et al. Influence of surgical technique on early postoperative hypoxaemia in children undergoing elective palatoplasty. Br J Anaesth 1998;80:447-51.
23. Valnicek SM, Zuker RM, Halpern LM, Roy WL. Perioperative complications of superior pharyngeal flap surgery in children. Plast Reconstr Surg 1994;93:954-8.
24. Merry AF, Cooper JB, Soyannwo O, Wilson IH, Eichhorn JH. International standards for a safe practice of anesthesia 2010. Can J Anaesth 2010;57:1027-34.
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