Cleft Palate

Cleft Palate

  • Usually performed at ~1 year of age
  • Accompanied by ear tube placement
  • Premedication: versed 0.5-1mg/kg in response to patient's need, clinical status, and parents' input
  • Inhalational induction with nitrous oxide and sevoflurane
  • Peripheral IV after induction
  • +/- muscle relaxant/propofol to facilitate intubation of the trachea
  • Oral RAE tube (usually 4.0 cuffed, check for leak), secure with tegaderm--do not tape to vermillion of lower lip
  • Table turned 90 degrees
  • Dingman mouth gag inserted-may kink or reposition the endotracheal tube-Beware!
  • Awake extubation with gentle suctioning with a yankaur--avoid the palate by advancing along the center of the tongue.
  • Following extubation, airway obstruction is common, since closure of the cleft decreases the area in the posterior pharynx, pushing the tongue against the posterior pharynx. Often times the surgeons will place a tongue stitch to allow forward tongue displacement to unobstruct the airway after extubation of the trachea. Postoperative monitoring in the PICU may be required.
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This information is meant to serve as an educational resource. Clinicians should use their own professional judgment in the care of any individual patient as the guidance contained in this document may not be appropriate for all patients or all situations.