**5. Postanesthetic management**

*Current Treatment of Cleft Lip and Palate*

mask [3].

age [3, 18].

management and adverse respiratory events [2, 26, 27].

ing severity, requiring pediatric intensive care unit [17].

DiGeorge syndrome, and Marfan syndrome [2, 7, 13, 15].

lip and palate from 4.7 to 8.4% representing a greater risk of difficulty in airway

In 2002 Bordet reported an incidence of airway-related complications of 7.87% in children under general anesthesia, varying according to the type of instrumentation used: 7.4% with endotracheal tube and 10.2% with laryngeal

On the other hand, more than 500 related craniofacial syndromes such as Treacher Collins, Goldenhar, or Pierre Robin sequence increase the probability of difficult airway. Other related syndromes in the literature are Down syndrome,

Some researchers have established situations with a higher risk of adverse events during airway management; there is talk of difficult laryngoscopy in the presence of facial deformities such as micrognathia or bilateral complete fissures due to difficulty in positioning the laryngoscope blade altering the line of sight when falling into the left cleft. There is a greater likelihood of risks in patients with cleft lip with bilateral defects, while the difficulty in laryngoscopy and intubation in patients with cleft palate is related to age, being older at a younger

A larger number of laryngoscopies performed increases the likelihood of adverse events such as trauma and edema of the airway, laryngospasm, and bronchospasm. Airway management in patients with CLP has been studied for more than 70 years, increasing throughout history the indirect devices and techniques for the pediatric population that favor airway manipulation such as laryngeal masks, video laryngoscopes, and fibrobronchoscopies in their different versions; however, direct laryn-

Keeping patients in hemodynamic and ventilatory stability and reducing the risks of adverse events by providing individualized anesthetic management according to the characteristics and needs of each patient are part of our responsibility as anesthesiologists. Adequate anesthetic maintenance is achieved through the use of drugs that provide analgesia, hypnosis, amnesia, neurovegetative protection, and

There is no single recommended technique, nor one that offers greater advantage

over the others; within the general balanced anesthesia, the most reported technique is inhalation with sevofluorane, as it is considered the least pungent and the one that promotes greater hemodynamic stability. There are also reports of the use

The use of anesthetics that provide stability and intra- and postoperative analgesia is recommended, reducing doses of transoperative opioids, and with a lower risk of respiratory depression in the postanesthetic care, dexmedetomidine

Dexmedetomidine, a potent α2-specific adrenoceptor agonist with sedation, anxiolysis, and analgesia properties, has the advantages of not modifying respiratory recovery or extubation times and significantly reducing the risk of postopera-

goscopy without stiletto remains the most widely used method [14].

**4. Transanesthetic management**

neuromuscular block when necessary [21].

and ketamine are indicated [28, 29].

of isoflurane with or without a muscle relaxant [3, 18, 20].

The anatomical characteristics of the airway corresponding to the age group and those of the pathology are related to difficulties in the management of the airway at any time during the perioperative period, induction (ventilation, laryngoscopy, intubation), transanesthetic, extubation, or early postanesthetic period with vary-

**56**

tive agitation [20].

Corrective cleft palate surgery reports an incidence of postoperative adverse events of 13%, the highest in maxillofacial surgery; the main events reported are tongue edema, bleeding, pain, nausea, vomiting, bronchospasm, and agitation or delirium. Vigorous crying is frequent secondary to pain or agitation and when not treated promptly predisposes to wound dehiscence and pulmonary complications with great impact on the costs of delayed recovery and prolonged hospital stay [20, 28].

In 2018, a retrospective study was conducted to identify risk factors related to common adverse events in cleft lip and palate surgery; a relationship of adverse events was found with situations such as multiple attempts at intubation, structural or functional abnormality of the airway, surgery greater than 160 minutes, inexperience of the anesthesiologist, high doses of opioids, and no reversal of the neuromuscular blockade [30].
