Establishment, maintenance, and protection of the airway are the crucial goals of anesthesia for palate surgery. Failure to achieve these aims can result in tachypnea, hypercarbia, hypoxemia, increased bleeding, hypovolemia, arrhythmia, cardiac arrest, and death. The major cause of cardiac arrest in infants and children is hypoxemia.

Positioning of the patient is usually supine with the table rotated 90° to 180°. A preformed oral RAE (Ring-Adair-Elwyn) or reinforced ETT extends down the midline of the jaw taped to the chin. This type of ETT allows for easier visualization of the airway and decreased risk of inadvertent kinking intraoperatively. The mouth gag that is used for surgical exposure can be released intermittently to allow tongue reperfusion. However, each manipulation can affect positioning of the ETT. Blood that collects in the oropharynx should be carefully suctioned at the end of the procedure without disrupting the suture line. Residual blood and secretions in the oropharyngeal cavity can irritate the larynx and cause laryngospasm.

References

• Schendel SA, Yi Sun N, Agarwal R, Furukawa LK. Surgery for craniofacial malformations. In: Jaffe RA, Schmiesing CA, Golianu B, eds. Anesthesiologist's Manual of Surgical Procedures. 6th ed. Wolters Kluwer; 2020:1597-1628.