A study of anaesthetic management of cleft lip and palate surgery in children

This chapter discusses the anaesthetic management of the neonate, infant, and child. It begins with a description of neonatal physiology, then discusses fluid management, anaesthetic equipment, and the conduct of anaesthesia in children, including post-operative analgesia. Regional anaesthetic techniques in children are discussed, including caudal, epidural, spinal, and regional nerve blocks. Surgical procedures covered include repair of diaphragmatic hernia, gastroschisis/exomphalos, tracheo-oesophageal fistula, patent ductus arteriosus, pyloric stenosis, intussusception, herniotomy, penile circumcision, orchidopexy, hypospadias, cleft lip and palate, congenital talipes equinovarus, femoral osteotomy, and inhaled foreign body. It concludes with a discussion of paediatric medical problems, stabilization of the critically ill child, and paediatric sedation.

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Anaesthetic Management in a Child with Cutis Laxa for Bilateral Ureteric Reimplantation

Archives of Anesthesia and Critical Care ◽

10.18502/aacc.v7i3.6907 ◽

2021 ◽

Author(s):

Haripriya Ramachandran ◽

Dammaningala Venkataramaiah Bhagya

Keyword(s):

Heart Failure ◽

Connective Tissue ◽

Pulmonary Emphysema ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Preoperative Evaluation ◽

Anaesthetic Management ◽

Connective Tissue Disorder ◽

Cutis Laxa ◽

Facial Features

Cutis laxa is a rare congenital multisystem connective tissue disorder. Patients with cutis laxa can present with distinctive facial features, pulmonary emphysema and right-sided heart failure. Anaesthetic management is important because of difficult airway and respiratory/cardiac abnormalities. We have reported the preoperative evaluation and anaesthetic management of a child with Cutis laxa with right cleft lip and palate.

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Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0005 ◽

2019 ◽

Vol 4 (5) ◽

pp. 878-892

Author(s):

Joseph A. Napoli ◽

Linda D. Vallino

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

A Priori ◽

Sufficient Evidence ◽

Obstructive Sleep ◽

Before And After ◽

Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

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