Authors: Johannes Feyrer et al.
Pediatric Anesthesia August 16, 2025. doi:10.1111/pan.70038
This retrospective study reviewed 274 cases of children under 2 years of age who underwent cleft lip or palate surgery over an 8-year period at a German university hospital. The analysis focused on airway management strategies, the incidence of difficult or failed intubation, and perioperative complications, with special attention to syndromic patients.
Difficult laryngoscopy occurred in 6% of cases, and direct laryngoscopy failed in 1.9%, with video laryngoscopy proving successful in all failed attempts. Syndromic patients had a notably higher risk of difficult laryngoscopy (16.7% vs. 5.3%) and failed direct laryngoscopy (11.1% vs. 1.2%) compared to non-syndromic patients. Airway complications were also more frequent in syndromic cases (40.7% vs. 23.5%). In select high-risk cases, a hybrid intubation approach was employed successfully. The postextubation period was highlighted as especially challenging, with epinephrine inhalation suggested as a strategy to reduce reintubation risk and ICU admissions.
What you should know:
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Airway management in cleft lip/palate surgery is more complex in syndromic children.
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Syndromic patients face higher risks of difficult laryngoscopy, failed direct intubation, and perioperative complications.
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Video laryngoscopy is a reliable rescue technique when direct laryngoscopy fails.
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Hybrid intubation strategies may be appropriate when a difficult airway is anticipated.
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Postextubation management is critical; epinephrine inhalation may prevent complications.
Thank you to Pediatric Anesthesia for publishing this important work on airway management in pediatric cleft surgery.