Anesthetic management of children with cleft lip in a rural hospital in Sierra Leone. A purpose of two cases.
A. B. Ortega Floría1, T. Martínez Iturriaga2, F. Rivilla3, A. De Andrés4, E. Terol 5, F. Reinoso1
1Hospital Universitario La Paz - Madrid (Spain), 2Hospital San Rafael - Madrid (Spain), 3Hospital Ramón y Cajal - Madrid (Spain), 4Banco de España. Servicio médico. - Madrid (Spain), 5Hospital General Universitario Reina Sofía - Murcia (Spain)
Background: The practice of anaesthesia in developing countries is a challenge for any anaesthesiologist due to the scarcity of human and material resources and the associated diseases suffered by patients. Paediatric anaesthesia is a major problem because apart from all the above, the characteristics of children´s age and the typical diseases of these countries are added.1,3
Case Report: Two infants were scheduled for repair of unilateral labial cleft using Millard´s rotation-advance technique. Both procedures were performed under general intravenous anaesthesia, orotracheal intubation with flexometal tube and maintenance of ventilation with Mapleson C circuit connected to an oxygen concentrator. One of the babies presented a bronchospasm in the anesthetic induction that resolved with conventional treatment and the other patient had a extended awakening attributed to prolonged relaxation that required neuromuscular reversal treatment. Without significant incidents during both surgeries, the two girls were extubated in the operating room and went to the hospital ward. There were no complications during their hospital stay.
Discussion: Paediatric anaesthetic management in developing countries is an additional difficulty for anaesthesia technicians working in this environment. The lack of adequate materials ( it is very difficult to find paediatric sizes of masks, laryngoscope blades or pulse oximetry, for example) and the lack of proper training on the part of the anaesthesia staff (in the best case, many of them have education in anaesthesia for adults but little or no learning for the children), cause the perioperative morbidity and mortality rates to be much higher than ours.2
References: 1 Paediatric anaesthesia in developing countries. SC Hodges, I Walker et al. Anaesthesia 2007, 62 (Supl1):26-31. 2 Neonatal anaesthesia with limites resources. A Bösenberg. Paed Anaesth 24 (2014):98-105. 3 Challenges of anaesthesia in the management of the surgical neonates in Africa. G Amponsah. Afr J Paediatr Surg 2010, 7(3): 134-139.
Learning points: We need suitable material for children, we need more accesible training and education to our partners in these countries, we need the commitment of governements and institutions to promote training in neonatal and paediatric surgery and anaesthesia. With all this and many projects that are already underway, it will be possible to reduce perioperative mortality in children.


06 / Anesthetic management of the infant with cleft lip in a rural hospital in Sierra Leone. A purpose of two cases.