Nasal intubation and previous cleft palate repair

Abstract

The commonest complications seen by respondents were failure of either the spinal or epidural component of the block. Reported causes were inability to thread the epidural catheter (61%), presence of blood in the epidural catheter (59%) and pain on catheter advancement (40%). Post-dural puncture headache was estimated to be less frequent than 1 in 100 by the majority of anaesthetists (93%) with 19 reporting never having seen one. The observations of other more serious complications were recorded (see Table 1).The results show a wide variation in practice of CSE amongst experienced obstetric anaesthetists. The variation in practice reflects controversy over the technique used [1] and the potential for higher failure rates of CSE than individual spinal or other anaesthetic techniques [2,3]. There is concern over the frequency of complications with CSE [4][5][6]. A large prospective study or establishment of a database might shed further light on the frequency of failure and complications associated with different CSE techniques.

Trachlight for airway management in tongue flap division surgery

“…Trachlight has been used successfully in infants with difficult airway (5). We suggest that the use of trachlight for tracheal intubation can avoid unwanted stretch over the flap in such difficult airway scenario.…”

“…If children have not undergone pharyngoplasty or pharyngeal flap surgery, nasotracheal intubation is an acceptable choice (2,5). The nasal tube introduced through the nasal cavity does not interfere with anesthetist' view for the larynx during the laryngoscopy via the left molar approach.…”

Airway management for oral surgery in a patient with repaired cleft palate

“…[12] Since the defect is in midline in our case and nasal intubation was required, we opted for intubation using FOB. The alternate method of intubation is also described in the literature.…”

Airway management in children with division of tongue flap

“…Also children with cleft palate often have other craniofacial abnormalities which may interfere with laryngoscopy and intubation (4). In view of special difficulties during airway management in pediatric patients requiring division of tongue flap (2,5), we often select the different methods to safely secure the airway based on history of previous anesthesia and surgery, preoperative airway evaluation and surgical requirements. Here, we would like to introduce our practice and experience.…”

“…If children have not undergone pharyngoplasty or pharyngeal flap surgery, nasotracheal intubation is an acceptable choice (2,5). The nasal tube introduced through the nasal cavity does not interfere with anesthetist’ view for the larynx during the laryngoscopy via the left molar approach.…”