scholarly journals Preemptive analgesic effectiveness of single dose intravenous ibuprofen in infants undergoing cleft palate repair: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhe Zhe Peng ◽  
Yan Ting Wang ◽  
Ma Zhong Zhang ◽  
Ji Jian Zheng ◽  
Jie Hu ◽  
...  
Keyword(s):  
Single Dose ◽  
Adverse Events ◽  
Cleft Palate ◽  
Controlled Trial ◽  
Postanesthesia Care Unit ◽  
Rescue Analgesia ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Intravenous Ibuprofen

Abstract Background Correction surgery for cleft palate is recommended between 9 and 18 months of age. Patients suffer from acute pain after palatoplasty. Clinicians are hesitant to use opioids for analgesia concerning the potential high risk of respiratory adverse events. Intravenous ibuprofen perhaps be a suitable adjuvant to pain relief. We try to assess whether preoperative administration of intravenous ibuprofen can decrease opioid requirements following cleft palate repair in infants. Methods This single center prospective randomized clinical trial was performed from February to April 2021 at Department of Anesthesiology in Shanghai Children’s Medical Center. Forty patients ASA I-II, aged 9–24 months with isolated cleft palate and undergoing palatoplasty were randomized in a 1:1 ratio to receive either a single dose of 10 mg/kg ibuprofen intravenously or normal saline at induction. Children and infants postoperative pain scale (CHIPPS) was used for pain assessment. Those patients CHIPPS pain score equal or higher than 4 received analgesic rescue with titrating intravenous fentanyl 0.5 μg/kg and repeated in 10 min if required. The primary outcome was the amount of postoperative fentanyl used for rescue analgesia in postanesthesia care unit (PACU). Results Patients (n = 20 in each group) in IV-Ibuprofen group required less postoperative fentanyl than those in placebo group (p<0.001). There was no significant difference between two groups in first rescue analgesia time (p = 0.079) and surgical blood loss (p = 0.194). No incidence of obvious adverse events had been found within the first 24 h after surgery in both groups. Conclusions Preemptive intravenous administration ibuprofen 10 mg/kg at induction had a significant opioid sparing effect in early postoperative period without obvious adverse effects in infants undergoing palatoplasty. Trial registration CHICTR, CTR2100043718, 27/02/2021 http://www.chictr.org.cn/showproj.aspx?proj=122187

Tympanoplasty Results in Patients with Cleft Palate: An Age- and Procedure-Matched Comparison of Preliminary Results with Patients without Cleft Palate

2002 ◽  
Vol 126 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Edward Gardner ◽  
John L. Dornhoffer
Keyword(s):  
Cleft Palate ◽  
Published Data ◽  
Otologic Surgery ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Poor Outcomes ◽  
Matched Comparison ◽  
And Control ◽  
Palate Patient

OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap ( P = 0.6805), graft survival rate ( P = 1.00), and need for postoperative intubation ( P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

Analgesic effectiveness of acetaminophen for primary cleft palate repair in young children: a randomized placebo controlled trial

2014 ◽  
Vol 24 (6) ◽  
pp. 574-581 ◽  
Author(s):  
Chelan Nour ◽  
Joanna Ratsiu ◽  
Neeta Singh ◽  
Linda Mason ◽  
Andrea Ray ◽  
...  
Keyword(s):  
Young Children ◽  
Cleft Palate ◽  
Controlled Trial ◽  
Cleft Palate Repair ◽  
Palate Repair

scholarly journals The Use of Postoperative Restraints in Children after Cleft Lip or Cleft Palate Repair: A Preliminary Report

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Jennifer Huth ◽  
J. Dayne Petersen ◽  
James A. Lehman
Keyword(s):  
Postoperative Complications ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Suture Line ◽  
Convenience Sample ◽  
Study Results ◽  
Significant Difference ◽  
Cleft Lip Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Purpose. This study examines whether the use of elbow restraints after cleft lip/palate repair has a relationship to postoperative complications. Methods. A comparative descriptive design was used to study a convenience sample of children undergoing repair of cleft lip/palate at Akron Children’s Hospital with Institutional Review Board approval. The children were randomized into intervention or control groups with use of elbow restraints considered the intervention. The study consists of two arms; one examined children after cleft lip repair, the second examined children after cleft palate repair. Repairs were performed by a single surgeon. Data collected included age, comorbidities, patient discomfort measured by pain score, frequency and duration of pain medications, use of pacifier or finger/thumb sucking, and postoperative complications including disruption of the suture line. Results. With 47 post palate repair patients and 47 post cleft repair patients, there is no significant difference () in the occurrence of postoperative complications. Conclusions. Study results provide prospective evidence to support postoperative observation of children by surgery staff and family following cleft lip or cleft palate repair without the use of elbow restraints. Clinicians should reevaluate the use of elbow restraints after cleft lip/palate repair based on the belief restraints prevent postoperative complications.

Predictors of Adverse Events Following Cleft Palate Repair

2019 ◽  
Vol 30 (5) ◽  
pp. 1414-1418 ◽  
Author(s):  
Elbert Johann Mets ◽  
Fouad Chouairi ◽  
Sina John Torabi ◽  
Michael Alperovich
Keyword(s):  
Adverse Events ◽  
Cleft Palate ◽  
Cleft Palate Repair ◽  
Palate Repair

Optimal Timing of Palatoplasty in Infants With Comorbidities

2020 ◽  
pp. 105566562097624
Author(s):  
Christopher L. Kalmar ◽  
Vijay A. Patel ◽  
Zachary D. Zapatero ◽  
Mychajlo S. Kosyk ◽  
Jesse A. Taylor
Keyword(s):  
Adverse Events ◽  
Cleft Palate ◽  
Perioperative Complications ◽  
Perioperative Outcomes ◽  
Optimal Timing ◽  
Improvement Program ◽  
Surgical Quality ◽  
American College Of Surgeons ◽  
Cleft Palate Repair ◽  
Palate Repair

Objective: Ideal timing of palatoplasty continues to be debated given that early repair is thought to improve speech and hearing, whereas delayed repair is associated with less midface growth disruption. The purpose of this study is to elucidate optimal timing of palatoplasty in patients with comorbidities to mitigate perioperative complications. Design: Retrospective cohort study. Setting: Hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program Pediatric. Patients: Palatoplasty performed for children younger than the age of 2 years with comorbidities. Outcomes: Medical/surgical complications, reoperations, readmissions within 30 days postoperatively. Results: Patients with comorbidities having Veau I or II cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 125 days of age ( P < .001). Patients with comorbidities having Veau III cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 225 days of age ( P = .010). Patients with comorbidities having Veau IV cleft palate were associated with significantly decreased risk of adverse events when performing palatoplasty after 250 days of age ( P = .045). Conclusions: Infants with comorbidities having progressively increasing Veau classification demonstrate unique age-dependent perioperative thresholds, such that more extensive phenotypes are associated with better perioperative outcomes with older age at time of cleft palate repair.

Comparison of Codeine Phosphate and Morphine Sulphate in Infants Undergoing Cleft Palate Repair

2007 ◽  
Vol 44 (5) ◽  
pp. 528-531 ◽  
Author(s):  
S. Fenlon ◽  
N. Somerville
Keyword(s):  
Cleft Palate ◽  
Analgesic Effect ◽  
Outcome Measure ◽  
Codeine Phosphate ◽  
Double Blind ◽  
Pain Scores ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Clinically Significant

Objective: To ascertain the quality of analgesia provided by morphine in comparison to codeine. Design: The study is a prospective, randomized, double-blind trial of analgesic effect employing validated pain scores. Patients: Infants having primary cleft palate repair with informed parental consent to enter the study. Interventions: Infants received one of two analgesics intraoperatively for immediate postoperative pain relief. Morphine was given by intravenous injection and codeine by the intramuscular route. Main Outcome Measure: Pain scores in the immediate postoperative period for 2 hours following surgery; this outcome measure was decided prior to data collection. Results: The pain score and other outcome measures were all blinded. Measurements are all evident from the nature of the results. Conclusions: There was no clinically significant difference observed in the analgesic effect of either drug on the two groups studied.

Oronasal Fistula Incidence Associated With Vomer Flap Repair of Cleft Palate: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 105566562097456
Author(s):  
Katherine Vandenberg ◽  
Michael Castle ◽  
Fares Qeadan ◽  
Tania Kraai
Keyword(s):  
Systematic Review ◽  
Cleft Palate ◽  
Meta Analysis ◽  
Random Effect ◽  
Oronasal Fistula ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Syndromic Diagnosis ◽  
Palate Repair ◽  
Vomer Flap

Objectives: To determine the incidence of oronasal fistulas (ONF) associated with primary repair of the anterior palate using a single-layered, superiorly based, vomer mucoperiosteal flap. Design: A systematic review of MEDLINE, PubMed, Cochrane, and Web of Science databases using the keywords: “vomer flap” and “cleft palate repair” were carried out. A meta-analysis was performed using random effect modeling with stratified analysis by syndromic diagnosis, number of surgeons, and mean age. Main Outcome Measure(s): Incidence of ONFs. Results: The meta-analysis included 9 studies with a total of 464 children who met inclusion criteria. The overall ONF rate was 3.0% (95% CI: 1.0-9.0). Fistula rates were not significantly different in studies that included syndromic patients compared to studies that did not, 5.0% (95% CI: 1.0-24.0) versus 3.0% (95% CI: 1.0-6.0), respectively. There was no significant difference between studies in which there was a single surgeon versus multiple surgeons, 3.0% (95% CI: 1.0-13.0) versus 4.0% (95% CI: 1.0-8.0), respectively. Age at the time of cleft repair showed no statistically significant difference in fistula rate when comparing children with a mean age less than 12 months to those greater than 12 months, 3.0% (95% CI: 1.0-5.0) versus 5.0% (95% CI: 1.0-28.0), respectively. Conclusions: The vomer flap technique in cleft palate repair appears to be associated with a low ONF rate unaffected by syndromic diagnosis, number of surgeons, or patient age at time of repair.

scholarly journals A new congenital cleft palate New Zealand rabbit model for surgical research

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Haoyue Liu ◽  
Lingling Pu ◽  
Chialing Tsauo ◽  
Xiaoming Wang ◽  
Qian Zheng ◽  
...  
Keyword(s):  
New Zealand ◽  
Cleft Palate ◽  
Rabbit Model ◽  
Tube Feeding ◽  
Zealand Rabbit ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Congenital Cleft ◽  
Palate Repair ◽  
Anatomical Defects

AbstractCleft palate repair is a challenging procedure for cleft surgeons to teach, and in research, it can be difficult to evaluate different techniques and develop new treatments. In this study, a congenital cleft palate New Zealand rabbit model has been described and could be beneficial in future studies concerning cleft palate repair. Pregnant New Zealand rabbits received 1.0 mg dexamethasone injection intramuscularly once a day from the 13th gestation day (GD13) to GD16. On GD31. Newborn rabbits were delivered by cesarean sections, fed with a standardized gastric tube feeding method, and divided into two groups. The rate of survival and the incidence of cleft palate was calculated. Weight, appearance, behavior, maxillary occlusal view, and regional anatomic and histological comparisons were recorded within 1 month after birth. Infants from the two groups with similar physiological conditions were selected for continuous maxillofacial and mandibular Micro-CT scan and three-dimensional reconstruction analysis. Ten pregnant rabbits gave birth to 48 live infants. The survival and cleft palate rates were 65.6% and 60.4% respectively. Both groups survived over 1 month with no difference in weight, appearance, and behavior. The cleft type was stable, and anatomical defects, histological characteristics, and nasal-maxillary abnormalities of the cleft were similar to those of humans. There was no statistically significant difference in maxillary and mandible development between the two groups within one month after birth. This congenital cleft palate model is considered to have more research possibilities with efficient cleft induction, reliable feeding methods, stable anatomical defects, and maxillofacial development similar to those seen in humans.

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