Difficult Airway Management in Neonates and Infants Undergoing Cleft Palate Surgery

Abstract

Background: Cleft palate is a common congenital anomaly affecting approximately 1 in 700 live births, often requiring early surgical intervention that presents significant airway management challenges due to anatomical deformities and physiological immaturity in neonates and infants. These challenges increase the risk of perioperative complications such as desaturation, laryngospasm, and failed intubation, necessitating advanced airway strategies and coordinated multidisciplinary care. Objective: To evaluate the effectiveness and complication profiles of various airway management techniques in neonates and infants undergoing cleft palate surgery, and to identify strategies that optimize intubation success while minimizing perioperative respiratory morbidity. Methods: A cross-sectional observational study was conducted over four months in three tertiary care hospitals in Lahore, Pakistan, involving 70 neonates and infants scheduled for cleft palate repair. Airway management techniques—including direct laryngoscopy, video laryngoscopy, and fiber-optic intubation—were compared for intubation success, intraoperative complications, and postoperative respiratory outcomes. Statistical analysis included chi-square tests, logistic regression, and subgroup analyses. Results: Fiber-optic intubation achieved the highest success rate (85%), followed by video laryngoscopy (70%) and direct laryngoscopy (30%) (p < 0.001). Oxygen desaturation occurred in 40% of cases, multiple attempts in 34.3%, and laryngospasm in 20%. Postoperative respiratory complications, particularly laryngospasm and reintubation, were significantly more frequent in neonates. Conclusion: Advanced airway techniques significantly improve intubation outcomes and reduce complications in neonates and infants undergoing cleft palate surgery. Fiber-optic and video laryngoscopy should be prioritized in perioperative protocols, especially in neonates.