The clinical observation of difficult laryngoscopy and difficult intubation in infants with cleft lip and palate

Abstract

Infants with cleft lip and palate, left cleft lip and alveolus, combined bilateral cleft lip and palate, micrognathia, and age <6 months were the important risk factors for difficult laryngoscopy. Difficult intubation occurred mainly in infants with laryngoscopic views of grade III and IV.

Airway and respiratory complications in children undergoing cleft lip and palate repair

“…Positioning the patient in the optimal sniffing position by the use of a shoulder roll, routine use of external laryngeal manoeuvre, intubating stylet and having a senior anaesthetist intubate the patient are quoted as being contributory towards an easier intubation. 4 Tracheal tube problems occurred in five patients (10%) in our study of which there was tube disconnection in three, compression in one and accidental extubation in one patient. All but one (disconnection) occurred in patients having CP repair.…”

“…This compares well to 4.77% obtained by Xue. 4 Difficult intubation occurred in a 18 month old child scheduled for CLP surgery during attempts at intubation under deep inhalational anaesthesia. The child was subsequently intubated under muscle relaxation by a consultant grade anaesthetist.…”

“…The difficulty in laryngoscopy and intubation seen in cleft palate patients is related to age, being higher in infants. 4 The risk of perioperative respiratory adverse effects is less if tracheal intubation is facilitated by muscle relaxants 8,9 and accidental extubation when positioning the head for surgery is minimised if the tube is placed 1.5 cm above the carina. 10 Recurrent infections of the nasal cavity and respiratory tract due to constant irritation and aspiration increase airway reactivity and may result in laryngeal and bronchospasm.…”

“…4,5 Various researchers have enumerated factors associated with an increased risk of airway complications in these patients. They include anatomical difficulty in placement of laryngoscope blade 6 , the presence of associated facial deformities, for example, micrognathia 4,7 and the degree of deformity with a higher risk occurring in combined bilateral clefts 4 . The difficulty in laryngoscopy and intubation seen in cleft palate patients is related to age, being higher in infants.…”

Anaesthesia for Cleft Lip and Palate Surgery: Study from a Hospital of Eastern Nepal

“…Difficult intuba on is known to be a main factor in deaths 28 associated with anesthesia in surgical pa ents. In our study total 21 (3.68%) cases recorded as a difficult intuba on and 1 28 case of failed intuba on.…”