**1. Introduction**

Anesthetic management in the pediatric population has a higher risk of adverse events compared to the adult population, mainly in children under 1 year of age due to the anatomical characteristics of the airway that predisposes them to difficulty in ventilation and intubation [1–3].

In order to improve the safety of patients in the perioperative period, studies have been carried out to establish risk factors. The second report of the pediatric perioperative cardiac arrest (POCA) found respiratory complications as one of the main causes of perioperative circulatory arrest [4], observing a high incidence even in the absence of active upper respiratory infection and significantly impacting the economy by increasing hospital stay and costs up to 30%. Laryngospasm, hypoxemia, and bronchospasm were considered as the most common adverse events related to anesthesia [4, 5].

When attempting to identify patients with high risk, greater vulnerability was observed in those undergoing head and neck surgery that involves airway and specifically those of surgical correction of the cleft lip and palate [5–7]. The cleft lip and palate is the most common craniofacial anomaly nomination in Latin America whose incidence in Mexico.

Cleft lip and palate (CLP) is the most common craniofacial anomaly in Latin America whose incidence in Mexico is 1 per 800–1000 live births registered with great medical, psychological, and social repercussions [7].

It is defined as an elongated opening due to fusion failure between the lateral and medial nasal processes with the maxillary process during the fifth to eighth week of embryonic development, the severity of which is in relation to the percentage of interruption [8–10].

There are multiple classifications of orofacial clefts; due to their location, they can be unilateral, bilateral, or midline, and by their description, they are complete, incomplete, or submucosal, and according to structures, they involved the tip of the nose, nasolabial groove, lips, gums, hard palate, soft palate, and uvula [9, 10].

The etiology is heterogeneous due to the interaction of genetic and environmental factors during the early stages of pregnancy such as exposure to tobacco, alcohol consumption, nutritional deficiencies, viral infections, and exposure to phenytoinlike teratogens, valproic acid, thalidomide, and herbicides [8, 11]. Prenatal diagnosis of cleft lip can be performed reliably in the 18–20 weeks of gestation, while the cleft palate is difficult to identify before birth [10].

Bibliographic reviews based on advances in medical technology agree that although surgical repair of cleft lip and palate is not an emergency, it should be done at an early age; the objective is to favor dentition and the development of hearing and language and reduce the incidence of respiratory infections by offering better esthetic and functional results that impact on the quality of life at an individual, family, and social level, with a low morbidity rate and zero mortality [7, 9, 12]. Primary repair of cleft lip and tip of the nose is performed around 3 months of age and that of cleft and maxillary palate at 9–12 months of life [13, 14].


**53**

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

Surgical treatment of fissures is a challenge for the plastic or maxillofacial surgeon and for the anesthesiologist. As a historical background, the first references on the management of cleft lip and palate date back to 1847 with John Show who used chloroform as an anesthetic in the repair of lip fissures in 147 patients aged 3–6 weeks; in *The Lancet* magazine of 1850, the cleft lip and palate closure is mentioned in a 7-year-old male with 1-week interval between surgeries, and Magill in 1921 used a catheter for the first time endotracheal with the advent of halothane

It is currently known that there are determining factors for anesthetic management

Within the preanesthetic assessment of patients with CLP, it is mandatory to know:

b.Variety of pathology presentation: cleft lip, cleft palate, cleft lip and palate, and

c.Presence of difficult airway predictors for interrogation and physical

d.Presence of associated congenital anomalies or craniofacial syndromes.

e.Associated comorbidities such as heart disease, recurrent or active respiratory tract infections, poor management of oropharyngeal secretions, pneumopa-

The recommended age for surgical repair of cleft lip is 3–6 months, currently tends to be performed in the neonatal period with the implications of anesthetic management of this age group. Cleft palate repair is recommended at 9–12 months with reports up to 18 months [4, 10, 15]. There is evidence in the literature about a risk of complications 5 times greater during anesthetic management of children under 10 kg and under 10 weeks of age. A direct relationship between body weight at the time of surgery and the presence of complications has been observed; in patients weighing 4–6 kg, they occur in 54% and in patients weighing more than

According to the characteristics of the defect, the surgical experience, and the management institutions' protocols, the surgeon will determine the age of repair and the need for a primary or sequential closure in stages with the objective of

The male-female ratio is 2:1 in cases involving lip and 1:2 in cases involving only palate. As for laterality, the ratio is 2:1 left to right [14, 17]; greater risk of difficulty in airway management and secondary adverse events has been observed in patients

minimizing distortion in facial growth by very early repairs [10].

a.Demographic characteristics such as age, sex, and weight.

in corrective surgery of the lip and cleft palate related to the characteristics of the patient, his medical history or associated comorbidities, and the surgical technique. As it is the pathology with the highest incidence in facial malformations that requires surgical treatment, it is necessary to know the anesthetic management alternatives and establish criteria in the different stages of the perioperative period from preanesthetic assessment to postanesthetic care, in order to provide planned approach within the highest safety standards that reduce the risk of adverse events (**Table 1**).

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

and the piece in "T" [13].

**2. Preanesthetic assessment**

cleft palate with fistula.

thies, or obstructive apnea.

examination.

8 kg in 26% [13, 16].

#### **Table 1.**

*Factors to consider for the perioperative approach of patients with CLP.*

*Anesthesia Considerations in the Perioperative of Patients with Lip and Palate Length DOI: http://dx.doi.org/10.5772/intechopen.89953*

Surgical treatment of fissures is a challenge for the plastic or maxillofacial surgeon and for the anesthesiologist. As a historical background, the first references on the management of cleft lip and palate date back to 1847 with John Show who used chloroform as an anesthetic in the repair of lip fissures in 147 patients aged 3–6 weeks; in *The Lancet* magazine of 1850, the cleft lip and palate closure is mentioned in a 7-year-old male with 1-week interval between surgeries, and Magill in 1921 used a catheter for the first time endotracheal with the advent of halothane and the piece in "T" [13].

It is currently known that there are determining factors for anesthetic management in corrective surgery of the lip and cleft palate related to the characteristics of the patient, his medical history or associated comorbidities, and the surgical technique.

As it is the pathology with the highest incidence in facial malformations that requires surgical treatment, it is necessary to know the anesthetic management alternatives and establish criteria in the different stages of the perioperative period from preanesthetic assessment to postanesthetic care, in order to provide planned approach within the highest safety standards that reduce the risk of adverse events (**Table 1**).
