**4. Transanesthetic management**

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 neuromuscular block when necessary [21].

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

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 and ketamine are indicated [28, 29].

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 postoperative agitation [20].

**57**

*Anesthesia Considerations in the Perioperative of Patients with Lip and Palate Length*

The adverse events observed in the transanesthetic and related to the endotracheal

There are no criteria already established for the optimal time of extubation; it is an issue that continues to cause controversy. In general terms, extubation is recommended with a patient fully awake and with protective airway reflexes [3, 19].

Corrective cleft palate surgery reports an incidence of postoperative adverse events

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].

For many years the idea of immaturity of the nervous system in the pediatric population was defended, reducing the importance of acute and postoperative pain management; at present it is well-known that the structures responsible for pain

Postoperative pain from cleft lip and palate surgery is considered acute, superficial, somatic, and of significant intensity that causes irritability with vigorous crying [10, 28, 29]. The nerve branches involved depend on the type and location of the defect [10]:

• Intraorbital nerve, maxillary trigeminal branch, innervated upper lip, and

• External nasal nerve branch of the ophthalmic, innervates wing, and nasal tip

• Major palatine nerve, branch of the pterygopalatine ganglion. Inerva gums,

There is currently no pain management guide in patients with cleft lip and palate; each institution must, based on its experience and population needs, establish a protocol based on multimodal analgesia. This consists of the infiltration of local anesthetics, nerve blocks, opioid analgesics and non-opioid analgesics, providing

• Lesser palatine nerve; innervates soft palate, nostrils, and uvula

transmission are formed from the 30th week of gestation [10].

skin between upper lip and lower eyelid

• Branches of the maxillary trigeminal division

mucous membrane, and hard palate glands

• Nasopalatine nerve, innervates palatine region

sufficient analgesia with a lower risk of postoperative agitation [29]:

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].

tube are occlusion, bending or accidental removal by surgical manipulation [18].

*DOI: http://dx.doi.org/10.5772/intechopen.89953*

**5. Postanesthetic management**

**5.1 Pain management**

a.Cleft lip

b.Cleft palate
