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  • Title: Can we predict a difficult intubation in cleft lip/palate patients?
    Author: Arteau-Gauthier I, Leclerc JE, Godbout A.
    Journal: J Otolaryngol Head Neck Surg; 2011 Oct; 40(5):413-9. PubMed ID: 22420397.
    Abstract:
    OBJECTIVE: To find predictors of a difficult intubation in infants with an isolated or a syndromic cleft lip/palate. STUDY DESIGN: Retrospective review: single-blind trial. SETTINGS: Tertiary care centre. METHODS: A total of 145 infants born with cleft lip/palate were enrolled. Three clinical and seven lip/palate anatomic parameters were evaluated. The grade of intubation was determined by the anesthesiologist at the time of the labioplasty/staphylorrhaphy surgery at 3 and 10 months, respectively. MAIN OUTCOME MEASURE: Intubation grade. RESULTS: The relative risk of a difficult intubation in the cleft lip, cleft palate without the Pierre Robin sequence, cleft lip-palate, and cleft palate with Pierre Robin sequence groups was 0, 2.7, 10, and 23%, respectively. The infants born with the Pierre Robin sequence had a statistically significant higher intubation grade. The degree of difficulty was increased in cases with early airway and feeding problems (p < .0001). Within the group of cleft palate patients without any lip malformation, a wider cleft was associated with a higher intubation grade with statistical significance (p  =  .0323). CONCLUSIONS: Infants born with Pierre Robin sequence have a statistically significantly higher risk of difficult intubation. Within this group, of all the studied factors, a clinical history of early airway and feeding problems was the best predictor of a difficult endotracheal intubation. In cleft palate patients without any cleft lip, larger width of the cleft is also a significant predictor.
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