Pediatric Surgery: Cleft Lip and Cleft Palate

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Questions and Answers

What is IPPV and why is it used in cleft lip and palate surgery?

IPPV stands for Intermittent Positive Pressure Ventilation, used to provide ventilation during general anesthesia.

What is the purpose of using a pharyngeal pack and taping the eyes during cleft lip and palate surgery?

To prevent aspiration and corneal dryness.

What is the role of Fentanyl and Paracetamol in peri-operative care for cleft lip and palate surgery?

They are used for pain management and to reduce post-operative pain.

Why is Dexamethasone 0.1 mg/kg used in peri-operative care for cleft lip and palate surgery?

To reduce post-operative swelling and edema by reducing vascular permeability. Signup and view all the answers

What is the recommended position for extubation after cleft lip and palate surgery?

The tonsillar position (lateral and head down position). Signup and view all the answers

What is the significance of suctioning the pharynx cautiously during post-operative care?

To prevent damage to the repair site. Signup and view all the answers

Why is it recommended to use opioids cautiously in patients with airway problems undergoing cleft lip and palate surgery?

To avoid respiratory depression and airway complications. Signup and view all the answers

What is the benefit of early cleft lip repair in terms of surgical scar appearance?

Improved appearance of the surgical scar. Signup and view all the answers

What is the frequency of congenital abnormalities of cleft lip and palate?

1 in 600 births Signup and view all the answers

What percentage of cases involve both the lip and palate together?

50% Signup and view all the answers

What medication should be given 30 minutes preoperatively if a difficult airway is suspected?

IM atropine 20 micrograms/kg Signup and view all the answers

What type of induction is recommended when there is an airway problem?

Inhalational induction Signup and view all the answers

Why is local infiltration of Lidocaine with Adrenaline used in cleft lip and palate surgery?

Produces good analgesia, clear operating field, and low blood loss Signup and view all the answers

What is the risk of using RAE tube in cleft lip and palate surgery?

May be obstructed or kinked by the mouth gag Signup and view all the answers

What type of tube is recommended instead of RAE tube in cleft lip and palate surgery?

Armored endotracheal tube Signup and view all the answers

Why are armored endotracheal tubes used in cleft lip and palate surgery?

Resist compression and kinking Signup and view all the answers

Study Notes

Pediatric Surgery and Anesthesia: Cleft Lip and Cleft Palate

Congenital Abnormalities

Cleft lip and palate are congenital abnormalities that occur in 1 in 600 births.
Both the lip and palate are involved together in 50% of cases (30% lip, and 25% palate).
Associated with congenital cardiac disease, ear malformation, or facial bones deformity.

Pre-Operative Assessment and Preparation

Assess and examine the airway to predict difficult intubation.
Discuss risks and complications with the family and obtain consent for operation.
Give IM atropine 20 micrograms/kg 30 minutes preoperatively if a difficult airway is suspected.

Monitoring

Pulse oximetry
ETCO2
ECG
Non-invasive BP
Stethoscope
Core temperature

Peri-Operative and Induction of Anesthesia

Inhalational or IV induction
Use Halothane or Sevoflurane for inhalational induction if airway problem is suspected
Intubate deep with the child breathing spontaneously or following muscle relaxant
Local infiltration of Lidocaine with Adrenaline for good analgesia and low blood loss

Anesthesia Management

Use armored endotracheal tubes (cuffed, wire-reinforced, silicone rubber tubes) to resist compression and kinking
Use IPPV (intermittent positive pressure ventilation)
Use a throat (pharyngeal) pack and protect the eyes with tape to prevent corneal dryness

Pain Management

Fentanyl (2-4 micrograms/kg) and Paracetamol by IV/PR or NSAIDS by PR (suppository) for analgesia
Ketamine can be used
Dexamethasone 0.1 mg/kg to prevent post-operative swelling and edema

Post-Operative Care

Extubate fully awake, breathing adequately, and in the tonsillar position (lateral and head down position)
Suction the pharynx cautiously to prevent damage to the repair site
Routine post-operative analgesia includes Paracetamol and NSAIDS by PR (per-rectum)

Special Considerations

Intubation may be difficult and complicated due to cleft palate
Roll of gauze can fill the gap (cleft) during laryngoscopy
Prolonged surgery may cause a swollen tongue from pressure of the mouth gag
Opioids should be given cautiously with airway problems
Post-operative monitoring should include pulse oximetry
Cleft lip is usually repaired at neonate to three months of age, and cleft palate done at 6-12 months of age

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Description

This quiz covers congenital abnormalities, pre-operative assessment, and anesthesia in pediatric surgery, specifically cleft lip and cleft palate. Topics include associated congenital diseases, airway assessment, and risks and complications.