Experience with Anaesthesia for Cleft Surgery in a Smile Train Partner Hospital in a Low- and Middle-Income Country.

Abstract

Background: Patients with cleft lips and palate (CLP) pose a high perioperative risk. Specialized anaesthesia is therefore required to improve outcomes. The experience with anaesthesia for patients scheduled for cleft surgeries at the University of Port Harcourt Teaching Hospital, a Smile Train partner hospital in Nigeria-West Africa (a low- and middle-income country-LMIC), from January 2020 to June 2023 is hereby presented.

Methodology: Data on demography, clinical and perioperative characteristics of patients billed for CLP surgery from January 2020 to June 2023 were collected, using records from patient’s folders, anaesthetic and theatre registers. SPSS v.22 was used for analysis and results presented as frequencies and percentages.

Results: A total of 94 patients were anaesthesized during the study period, including 10(10.6%) preoperative cancellations that were optimized. The mean age was 54.7±73.8 months, M:F ratio was 1:1.2, paediatric patients were 90(95.7%) and general anaesthesia (GA) with controlled ventilation was 93(98.9%). Surgeries were CP-49(52.1%), CL-42(44.7), and palatal fistula repair-3(3.2%). Preoperatively, 4 (4.3%) each had anaemia and upper respiratory tract infection which were treated. Mandatory monitoring included non-invasive blood pressure 94(100%), pulse oximetry 94(100%), ECG 94(100%) and end tidal CO₂ 93(98.9%). Intraoperatively, difficult intubation 6(6.4) and hypoxaemia 4(4.3%) were encountered; and postoperatively there was respiratory obstruction in 4(4.3%). All complications were successfully managed with full recovery.

Conclusion: With specialised perioperative care, anaesthesia for cleft surgeries can be associated with good outcomes in low- and middle-income countries (LMIC).