Murat TÜMER, Ayşe AYYILDIZ, Başak AKÇA, Aysun YILBAŞ, Filiz ÜZÜMCÜGİL, Özgür CANBAY

Perioperative Complications and Concomitant Diseases of Patients Followed in Intensive Care Unit After Cleft Lip-Palate Surgery

Objective: Patients with cleft lip/palate (CLCP) might need postoperative care in Intensive CareUnit (ICU) due to several reasons like difficult airway management, associated abnormalities andperioperative respiratory complications. Our aim was to evaluate the factors associated with difficult airway and need for postoperative ICU follow-up in patients with CLCP operated in ourinstitution.Method: Patients with CLCP followed up postoperatively in ICU between 2005-2013 were retrospectively reviewed.Results: Twenty patients were included to the study. Ten patients had CLCP, and 10 cases hadisolated cleft palate. Difficult intubation was seen in 8 patients. Difficult mask ventilation wasseen only in one patient with 22q11 deletion. All patients with difficult intubation had micrognathia. Nasal fiberoptic bronchoscopy was more commonly used in patients with difficult intubation. There was a statistically significant relationship between the presence of any systemicdisease and difficult intubation. Main reasons for ICU follow-up were the need for close monitoring and airway related problems.Conclusion: Difficult airway is a frequent problem in patients with CLCP even in the absence of adiagnosed syndrome. Patients with difficult airway or risk of postoperative airway obstructioncould be better followed in ICU during early postoperative period for rapid diagnosis and treatment of possible complications by experienced staff.

Yarık Damak-Dudak Cerrahisi Sonrası Yoğun Bakım Ünitesinde Takip Edilen Hastaların Perioperatif Komplikasyonları ve Eşlik Eden Hastalıkları

Amaç: Yarık dudak/damak (YDD) hastaları zor hava yolu yönetimi, eşlik eden anomaliler ve solunum komplikasyonları gibi çeşitli nedenlerden dolayı postoperatif dönemde Yoğun Bakım Ünitesinde (YBÜ) bakıma ihtiyaç duyabilirler. Amacımız, kurumumuzda opere edilen YDD’li hastalarda zor hava yolu ve postoperatif YBÜ takibine duyulan ihtiyaç ile ilişkili faktörleri değerlendirmektir. Yöntem: 2005-2013 yılları arasında YBÜ’de ameliyat sonrası takip edilen YDD hastaları retrospektif olarak incelendi. Bulgular: Yirmi hasta çalışmaya dahil edildi. On hastada yarık damak ve dudak birlikteyken, on hastada izole yarık damak vardı. Sekiz hastada zor entübasyon görüldü. Zor maske ventilasyonu sadece 22q11 delesyonu olan bir hastada görüldü. Entübasyonu zor olan tüm hastalarda mikrognati vardı. Nazal fiberoptik bronkoskopi zor entübasyonu olan hastalarda daha sık kullanıldı. Herhangi bir sistemik hastalığın varlığı ile zor entübasyon arasında istatistiksel olarak anlamlı bir ilişki vardı. YBÜ takibinin ana nedenleri yakın monitörizasyon ihtiyacı ve hava yolu ile ilişkili problemlerdi. Sonuç: Zor hava yolu, eşlik eden tanılı bir sendromu olmasa bile YDD hastalarında sık görülebilen bir sorundur. Zor hava yolu veya postoperatif hava yolu obstrüksiyonu riski olan hastalar, deneyimli bir personel tarafından olası komplikasyonların hızlı teşhisi ve tedavisi için erken postoperatif dönemde yoğun bakımda daha iyi takip edilebilir.

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1. Sharif F, Mahmood F, Azhar MJ, et al. Incidence and management of cleft lip and palate in Pakistan. JPMA - The Journal of the Pakistan Medical Association. 2019;69:632-9.

2. Leslie EJ, Marazita ML. Genetics of cleft lip and cleft palate. Am J MEd Genet Part C Semin Med Genet. 2013;163C:246-58. https://doi.org/10.1002/ajmg.c.31381

3. Jackson O, Basta M, Sonnad S, Stricker P, LaRossa D, Fiadjoe J. Perioperative risk factors for adverse airway events in patients undergoing cleft palate repair. The Cleft Palate-Craniofacial Journal. 2013;50:330-6. https://doi.org/10.1597/12-134

4. Mukozawa M, Kono T, Fujiwara S, Takakura K. Late onset tongue edema after palatoplasty. Acta Anaesthesiologica Taiwanica. 2011;49:29-31. https://doi.org/10.1016/j.aat.2011.01.004

5. Brailsford J, Smith D, Lizarraga A, Bermudez L. Surgical management of patients with cleft palate. Or Nurse. 2010;4:16-25. https://doi.org/10.1097/01.ORN.0000372493.61514.da

6. Mossey PA, Modell B. Epidemiology of oral clefts 2012: an international perspective. In: Cobourne MT, editor. Cleft Lip and Palate. Epidemiology of oral clefts 2012: an international perspective. London: Karger Publishers; 2012. pp.1-18. https://doi.org/10.1159/000337464

7. Rittler M, Cosentino V, López‐Camelo JS, Murray JC, Wehby G, Castilla EE. Associated anomalies among infants with oral clefts at birth and during a 1‐year follow‐up. Am J Med Genet Part A. 2011;155:1588-96. https://doi.org/10.1002/ajmg.a.34046

8. Adesina OA, Efunkoya AA, Olaitan A, Adesina OO. Associated anomalies in cleft lip and palate: analysis of 811 consecutive patients. South Sudan Medical Journal. 2017;10:60-3.

9. Heinrich S, Birkholz T, Ihmsen H, Irouschek A, Ackermann A, Schmidt J. Incidence and predictors of difficult laryngoscopy in 11.219 pediatric anesthesia procedures. Pediatric Anesthesia. 2012;22:729-36. https://doi.org/10.1111/j.1460-9592.2012.03813.x

10. Brzenski A, Ham-Mancilla O, Peña-Olvera S, Gosman A, Sigler A. Pediatric Anesthesia for Patients with Cleft Lip and Palate. In: Whizar-Lugo VM, editor. Anesthesia Topics for Plastic and Reconstructive Surgery. Intech Open; 2018. https://doi.org/10.5772/intechopen.74926

11. Raghavan U, Vijayadev V, Rao D, Ullas G. Postoperative management of cleft lip and palate surgery. Facial Plastic Surgery. 2018;34:605-11. https://doi.org/10.1055/s-0038-1676381

12. Apfelbaum JL, Hagberg CA, Caplan RA, et al. Practice guidelines for management of the difficult airway an updated report by the American Society of Anesthesiologists task force on management of the difficult airway. Anesthesiology. 2013;118:251-70. https://doi.org/10.1097/ALN.0b013e31827773b2

13. Xue FS, Huang YG, Luo LK, et al. Observation of early postoperative hypoxaemia in children undergoing elective plastic surgery. Pediatric Anesthesia. 1996;6:21-8. https://doi.org/10.1111/j.1460-9592.1996.tb00347.x