Af Faponle

Pre-operative haematological investigations in paediatric orofacial cleft repair: Any relevance to management outcome?

AIM AND OBJECTIVES To determine the value of routine pre-operative haematologic investigations in children undergoing orofacial cleft repair. BACKGROUND Although routine pre-operative laboratory screening tests are carried out traditionally, some studies suggest that they are not absolutely necessary in the management of elective surgical patients. MATERIALS AND METHODS This is a prospective cohort study carried out at a tertiary health facility located in Nigeria. A review of the laboratory investigations in 116 paediatric orofacial cleft patients undergoing surgery during a 6-year period was undertaken. Pre-operative laboratory investigations and peri-operative transfusion records were analysed for the frequency and impact of abnormal results on treatment plan and outcome using the Statistical Packages for the Social Scientists 16.0. RESULTS All the children had pre-operative packed cell volume (PCV) check on admission for surgery. The PCV ranged from 23% to 43%, mean was 32.9 (±3.7%). Twenty-two children (18.6%) had sub-optimal PCV (<30%). Patients with the lowest PCV values (23% and 26%) were transfused pre-operatively. The lowest post-operative PCV was 23%, mean 30.8 (±3.3%). There was no occasion of post-operative blood transfusion. Eighty-six patients (72.9%) had full or partial serum electrolyte and urea analysis. Screening for sickle-cell disease was rarely done. Fourteen intra- and post-operative complications were recorded. None of these were predictable by the results of pre-operative screening tests carried out. All the children were discharged home in satisfactory condition. CONCLUSIONS Routine laboratory testing has minimal impact on management and outcome of orofacial cleft surgeries. However, haematocrit screening may be appropriate, particularly in clinically pale patients.

Perioperative adverse airway events in cleft lip and palate repair

Abstract Background: Airway-related problems account for the majority of anaesthetic morbidity in paediatric anaesthesia, but more so for cleft lip and palate repair. The aim of this study was to assess the frequency, pattern, management and outcome of adverse airway events during the perioperative period in cleft lip and palate patients. Method: This was a prospective cohort study conducted in a tertiary hospital in a suburban south-western Nigerian town. One hundred and sixteen patients who had cleft lip and palate repair over a five-year period were included. The demographic data, surgical diagnosis, congenital anomalies, procedures performed, medical problems, perioperative anaesthetic and surgical complications were studied. Results: Adverse airway events were observed in six patients (4.6%). These included postoperative chest infection (n=2), failed intubation (n=1), difficult intubation (n=1), post-extubation bronchospasm (n=1), and laryngeal oedema (n=1). All, except one, who developed complications were patients with combined cleft lip and palate. No mortality was recorded. Conclusion: Adverse perioperative airway events in cleft lip and palate surgery are common and are more likely to be associated with combined cleft lip and palate than with isolated lip or palate defects. These complications usually occur immediately following extubation or in the early postoperative period. The severity may necessitate intensive care unit admission and specialised care.

Post-operative symptoms at home in children following day case surgery

Abstract Background: This prospective questionnaire-based study examined the post-operative symptoms encountered by children who underwent day case surgery at a dedicated day case surgery unit. The study evaluated the post-operative symptoms that occurred at home. The parents evaluated the instructions given in the hospital for care at home. Methods: All children aged 1 day -14 years, who were operated on over a one year period were prospectively followed up following elective day case surgery. The incidence and duration of symptoms occurring after discharge was evaluated, using a structured questionnaire completed by the parents. The instructions given in hospital for care at home were evaluated by the parents using a different questionnaire. Results: A total of 100 children were operated on during the period. Pain (72%), emetic symptoms (16%) and difficulty with walking(7%) were the commonest symptoms occurring on the way home. There were no unplanned re-admissions. Two- thirds of the parents did not know enough about the treatment of the wound and of the overall recovery of the child. Conclusions: Post operative symptoms following elective day case surgery are amenable to treatment and prevention with a wider use of available drugs.