Anesthetic management in cleft lip and palate repair in children: a retrospective analysis.

Introduction To evaluate specific anesthetic approaches in pediatric patients undergoing surgical correction of congenital cleft lip and/or palate, focusing on airway management, induction technique, complication rates, and analgesic ef- ficacy. Materials and Methods A retrospective review of 84 pediatric patients aged 3 to 36 months who underwent cleft lip or palate repair be- tween 2014 and 2024 in a pediatric maxillofacial surgery department. Parameters included method of induction, airway approach, use of anesthetic and analgesic agents, and intra-/postoperative complications. Statistical analy- sis was performed using SPSS v22.0; p < 0.05 was con- sidered significant. Results Inhalational induction with preserved spontaneous breathing was used in 85.7% of patients. Difficult intuba- tion (Cormack–Lehane grade ≥3) occurred in 19% of cases. Postoperative respiratory events were recorded in 11.9%, predominantly in patients with syndromic fea- tures. Multimodal analgesia was used in 92.9%, and local infiltration was performed in 76.2% of patients. Pain scores (FLACC scale) remained below 3 in 83.3% of children at 2 hours postoperatively. Conclusion Cleft lip and palate patients present a high risk of airway difficulty, necessitating careful preoperative planning and access to advanced airway tools. Inhalational induc- tion with spontaneous ventilation remains safe and effec- tive. Multimodal pain management, including non-opioid systemic agents and local infiltration, provides excellent analgesia and minimizes opioid-related complications.