Anaesthesia for cleft and lip palate surgery - Revision history

WikiSysop: /* Extubation and postoperative care */

2025-09-25T00:57:56Z

Extubation and postoperative care

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	Children can be reluctant to feed and intravenous fluids should be		Children can be reluctant to feed and intravenous fluids should be continued until adequate oral intake is established.

	~~continued until adequate oral intake is established.~~


			Post-operative analgesia includes opioids administered as intravenous boluses, continuous infusions or nurse controlled analgesia according to locally developed protocols, as well as regular paracetamol and NSAIDS (for those over 6 months).
	Post-operative analgesia includes opioids administered as intravenous boluses, continuous infusions or nurse controlled analgesia according to locally developed protocols, as well as regular paracetamol and NSAIDS (for those over 6 months).

	== '''References''' ==		== '''References''' ==

WikiSysop at 00:35, 25 September 2025

2025-09-25T00:35:21Z

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	== '''Introduction''' ==		== '''Introduction''' ==
			[[File:CLP fig1a.jpg\|thumb]]
	Cleft lip and palate (CLP) is one of the commonest congenital deformities. The associated facial disfigurement causes feeding, speech and dental development problems and has significant psychosocial consequences. Surgery aims to restore form and function, and modern techniques can leave many defects undetectable. Airway management problems, dealing with associated abnormalities and young patients all present anaesthetic challenges.		Cleft lip and palate (CLP) is one of the commonest congenital deformities. The associated facial disfigurement causes feeding, speech and dental development problems and has significant psychosocial consequences. Surgery aims to restore form and function, and modern techniques can leave many defects undetectable. Airway management problems, dealing with associated abnormalities and young patients all present anaesthetic challenges.

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	== '''Surgical Repair''' ==		== '''Surgical Repair''' ==
			[[File:CLP fig1.jpg\|thumb]]
	CL is classically repaired between 6 and 12 weeks but there is an increasing trend to operate in neonatal period. More popular with parents, this has a positive influence on the associated sleep disordered breathing problems, and also produces better aesthetic results and may promote bonding. CP is usually repaired later, between 3 and 9 months, in a one or two stage operation to promote normal speech development and reduce nasal regurgitation. Surgery may be delayed due to associated abnormalities, or more commonly lack of access to appropriate services CLP patients are likely to require further surgery either related to the primary problem e.g. plastic improvements to a CL repair, or for associated abnormalities. Around 20% will require pharyngoplasty for velopharyngeal dysfunction at around 4-6 years.		CL is classically repaired between 6 and 12 weeks but there is an increasing trend to operate in neonatal period. More popular with parents, this has a positive influence on the associated sleep disordered breathing problems, and also produces better aesthetic results and may promote bonding. CP is usually repaired later, between 3 and 9 months, in a one or two stage operation to promote normal speech development and reduce nasal regurgitation. Surgery may be delayed due to associated abnormalities, or more commonly lack of access to appropriate services CLP patients are likely to require further surgery either related to the primary problem e.g. plastic improvements to a CL repair, or for associated abnormalities. Around 20% will require pharyngoplasty for velopharyngeal dysfunction at around 4-6 years.

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			[[File:CLP fig3a.jpg\|thumb\|Figure 3. Cleft Palate Repair]]
	If available, modern anaesthetic machines with integral ventilators allow the anaesthetist to select his or her preferred technique. Drawover systems are more commonworldwide and are sufficient for CLP surgery. A standard system may include a vaporiser such as the Epstein Macintosh Oxford (EMO) for ether or Oxford Miniature Vaporiser (OMV) for halothane connected in series to an Oxford Inflating Bellows (OIB; Penlon, Abingdon, UK, See Drawover Anaesthesia article, page XXXXX). Drawover systems are not suitable for children who weigh less than 20kg due to high respiratory resistance. Attaching a Jackson Rees circuit to an OIB is an example of a suitable modification; the positive-pressure ventilation required for neonates and infants is possible with the bag of the T-piece whilst the OIB can be used to generate a fresh gas flow.		If available, modern anaesthetic machines with integral ventilators allow the anaesthetist to select his or her preferred technique. Drawover systems are more commonworldwide and are sufficient for CLP surgery. A standard system may include a vaporiser such as the Epstein Macintosh Oxford (EMO) for ether or Oxford Miniature Vaporiser (OMV) for halothane connected in series to an Oxford Inflating Bellows (OIB; Penlon, Abingdon, UK, See Drawover Anaesthesia article, page XXXXX). Drawover systems are not suitable for children who weigh less than 20kg due to high respiratory resistance. Attaching a Jackson Rees circuit to an OIB is an example of a suitable modification; the positive-pressure ventilation required for neonates and infants is possible with the bag of the T-piece whilst the OIB can be used to generate a fresh gas flow.

WikiSysop at 00:22, 25 September 2025

2025-09-25T00:22:52Z

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WikiSysop at 00:16, 25 September 2025

2025-09-25T00:16:32Z

← Older revision		Revision as of 00:16, 25 September 2025
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	Reprinted with minor revisions from Rawlinson E. Anaesthesia for cleft lip and palate surgery. ''Anaesthesia Tutorial of the Week'' 72 (2007).		Reprinted with minor revisions from Rawlinson E. Anaesthesia for cleft lip and palate surgery. ''Anaesthesia Tutorial of the Week'' 72 (2007).

	Ellen Rawlinson		Ellen Rawlinson, Consultant, Paediatric Anaesthetist, Great Ormond Street Hospital, London, UK

	Correspondence Email: Ellen.Rawlinson@gosh.nhs.uk		Correspondence Email: Ellen.Rawlinson@gosh.nhs.uk

WikiSysop at 00:14, 25 September 2025

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 This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.
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 Correspondence Email: Ellen.Rawlinson@gosh.nhs.uk
 '''Introduction'''

WikiSysop at 00:12, 25 September 2025

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	[[File:Wfsahq-logo.png\|200px\|thumb\|right]]		[[File:Wfsahq-logo.png\|200px\|thumb\|right]]
			{\| class="wikitable"
			\|+
			!Summary
			\|-
			\|


			Cleft lip and palate (CLP)

			is one of the commonest

			congenital deformities.

			Surgery aims to restore form

			and function, and modern

			techniques can leave many

			defects undetectable.

			Airway management

			problems, dealing with

			associated abnormalities

			and young patients all

			present anaesthetic

			challenges
			\|}
	This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.		This page is under construction, converting the originally formatted pdf from the WFSA site with wiki embellishments.

WikiSysop at 00:11, 25 September 2025

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 Primary palatoplasty disrupts normal palate growth and despite orthodontic treatment, some will require significant maxillofacial surgery in their teens to correct midface hypoplasia and maxillary retrusion
-'''Table 1:''' ''Syndromes and sequences associated with cleft lip and palate''
+Choanal stenosis or atresia
@@ Line 205: / Line 264: @@
 . Somerville N, Fenlon S. Anaesthesia for Cleft Lip and Palate Surgery. CEACCP, Jun 2005; 5: 76-79.

WikiSysop at 00:09, 25 September 2025

2025-09-25T00:09:44Z

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WikiSysop at 18:11, 11 September 2025

2025-09-11T18:11:04Z

← Older revision		Revision as of 18:11, 11 September 2025
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	''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''		''Originally from Update in Anaesthesia \| www.wfsahq.org/resources/update-in-anaesthesia''

			https://www.dropbox.com/scl/fi/8e65cbrknqz2zqxbhx3en/Update_30_2015_Paeds_lo_res_AW.pdf?rlkey=yfhwrksaowttpnurut8768kcx&st=wx6t9h5v&dl=0

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2021-03-05T02:34:12Z

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