Anesthesia for cleft lip and palate in children in resource lim-ited settings: a retrospective analysis of complications and as-sociated factors

Introduction Anesthesia for cleft lip and palate (CLP) repair remains challenging in children, particularly in resource-limited settings where airway management and monitoring ca- pacities are constrained. This study aimed to assess anes- thetic practices, perioperative complications, and associ- ated risk factors during CLP repair campaigns at Biamba Marie Mutombo Hospital. Methods A retrospective cross-sectional study was conducted from January 2021 to January 2024, including all chil- dren under 18 years who underwent primary or secondary CLP repair. Data were extracted from medical records, operative logs, and anesthesia sheets. Descriptive statis- tics were used to summarize clinical characteristics and complications. Logistic regression identified factors as- sociated with perioperative and postoperative adverse events. Results A total of 250 children were included. The median age was 7 months (IQR 4–12), and most were ASA I (90.8%). Difficult intubation occurred in 18.4% of cases. Periop- erative complications occurred in 19.2%, mainly desatu- ration (13.2%) and tachycardia (6%). Postoperative com- plications affected 14.8% of patients, predominantly de- layed awakening (13.6%) and endobuccal bleeding (1.2%). No deaths were reported. Independent predictors of perioperative complications were associated congeni- tal anomalies (adjusted OR 11.6; 95% CI 2.1–61.9) and anesthesia duration >1 hour (adjusted OR 2.4; 95% CI 1.2–4.6). Postoperative complications were inde- pendently associated with congenital anomalies (adjusted OR 41; 95% CI 4.7–352.3), anesthesia duration >1 hour (adjusted OR 4.3; 95% CI 1.9–9.4), and surgery duration >1 hour (adjusted OR 2.1; 95% CI 1–4.2). Conclusion CLP anesthesia in children remains high-risk, with air- way and recovery-related complications being the most frequent. Congenital anomalies and prolonged anesthesia significantly increase morbidity. Strengthening perioper- ative assessment, airway management strategies, and standardized protocols is essential to improving safety in resource-limited settings.