With the progress of society, people’s aesthetic concept is changing and everyone’s pursuit of beauty is increasing. The families of children with cleft lip and palate hope to repair the deformities of the child’s jaws and face as early as possible and to train functionally as early as possible. This way the age of surgery for children with cleft lip and palate continues to shrink, putting a lot of pressure on surgical anesthesia. With the continuous updating of anesthesia drugs and equipment; the advanced anesthesia management; and the increasing perfection of anesthesia techniques, we are more comfortable.
In infants and children with cleft lip and palate surgery, airway management becomes a priority because both the operating area and anesthesia are on the face. Children with cleft lip and palate often have cleft alveolar ridge, and the anatomical characteristics of the pediatric head, face and airway make tracheal intubation difficult, so it is important to prepare psychologically and with tools in advance. Before anesthesia, different types of tracheal tubes, cores, surface anesthetics, alveolar crest fillers or supports, laryngeal lenses of different lengths, suction devices, etc. should be prepared. The tracheal tube must be inserted gently. Infants and children often need to have an assistant press on the larynx during intubation to expose the voice box; when the tracheal tube passes through the voice box but cannot be further inserted, the tube must not be inserted forcibly or rotated.
We compared two methods of anesthesia maintenance for infant cleft lip and palate surgery and found that the use of mechanically controlled breathing during anesthesia can improve the safety of the child, and the increased intraoperative dose of remifentanil can reduce the stress response of the child without considering the suppression of spontaneous breathing. However, due to the pharmacokinetics of remifentanil and vancomycin in infants and children and the physiological peculiarities of infants and children, the incidence of delayed awakening sometimes increases after surgery and requires antagonism by drugs such as naloxone and neostigmine. The use of intraoperative maintenance of autonomic breathing group, the dosage of remifentanil is reduced, the child’s heart rate is fast and Etco2 is high, which makes the intraoperative anesthesia management more difficult. However, the rapid awakening and high quality of awakening in the spontaneous breathing group shortened the time of the child’s stay in the operating room. Since cleft lip and palate patients are mostly in remote rural areas and generally have low economic ability, the intraoperative mechanically controlled breathing group used significantly more drugs than the control group, which increased the cost and caused an impact on the patient’s family.