**7. Conclusions**

*Current Treatment of Cleft Lip and Palate*

nasopalatine is recommended [10].

sion such as dexmedetomidine and ketamine [3].

**5.2 Management of postoperative agitation**

a.Infiltration of local anesthetic at the surgical site. The use of long-acting bupivacaine-type AL calculated per kilogram of weight is suggested and

b.Nerve block. Age-related anatomical variants must be known, for example, the intraorbital stage is located very close to the eye [10, 29]. For lip surgery, the intraorbital stage with 1–2 ml of 0.5% bupivacaine with 1:200,000 epinephrine and 0.25 mm on each side of 0.25% bupivacaine with epinephrine is suggested. In palate surgery, the blockage of the major palatine, minor palatal, and

c.Opioid analgesics. Opioids are the first option for transoperative analgesia since they favor mild emersion and extubation, reducing the possibility of crying and consequently of trauma and bleeding. Its main disadvantage is the risk of postoperative dose-dependent respiratory depression and undesirable effects

d.Non-opioid analgesics. Bibliographic reviews recommend the use of adjuvants such as ibuprofen and acetaminophen in any age group; there is evidence on the decrease in postoperative pain supported by the FLACC scale (pain facies, leg movement, activity, comforting crying) with the administration of acetaminophen at the beginning of anesthesia and in the immediate postoperative period. It can be used as a premedication orally at a dose of 20 mg/kg [10].

Other recommended drugs are those that reduce the risk of respiratory depres-

The premise is to provide a state of complete patient well-being through multimodal analgesia; this technique emerged in 1997 and is based on the impact of several drugs at minimum doses on the different nociception mechanisms, with a lower risk of adverse effects. Management must be individualized considering

The incidence of agitation during emersion or in the postanesthetic is high (12–13%), with references up to 67%. The mechanism that originates it is not clear and has been related to factors such as psychological vulnerability of the patient (separation anxiety, fear of the unknown), anesthetic technique with halogenates, and surgical stimulation such as the subsequent narrowing of the nasopharyngeal cavity due to closure of the palate; other possible causes are postsurgical stimulation such as pain, hypoxemia, hyponatremia, hypoglycemia, CO2 retention, urinary

Clinically it is characterized by alterations in the state of consciousness or behavior, inconsolable crying, bedwetting, nightmares, anxiety, irritability, uncontrollable movements of limbs, and inability to identify objects or people. Drugs with evidence in reducing agitation are fentanyl, midazolam, and dexmedetomidine infusion [31].

Surgical correction of cleft lip and palate can be offered in various hospital settings from specialized institutions or as part of intensive care programs, so the medical staff responsible for surgical and anesthetic management is obliged to

factors such as age and degree of airway commitment [3, 10, 28, 29]

retention, postural discomfort, and/or a very rapid awakening.

consider the possible margin distortion when injected [11, 29].

such as dizziness, constipation, nausea, and vomiting [10, 29].

**58**

**6. Discussion**

Cleft lip and palate is the most frequent craniofacial pathology in Latin America coupled with the greater vulnerability of the pediatric population under 1 year to present perioperative adverse events; the objective of the approach will be to offer a properly planned comprehensive management within the maximum safety standards that reduce the morbidity and mortality of this population group.
