Following palatoplasty, the pharynx and nasopharynx are carefully suctioned before tracheal extubation. Some anesthesiologists advocate that this should be done with the aid of the laryngoscope to ensure removal of any mucus, blood, or clots. If suctioning is done before removing the Dingman gag, the laryngoscope might not be necessary. The infant should be as awake as possible. A long traction suture is placed through the tongue, tied loosely, and taped to the outside cheek for easy access. Traction on the suture stimulates respiration and clears the airway. Neither an oral nor a nasal airway should be inserted unless absolutely necessary; either one could disrupt the sutures and undo the surgical repair. The traction suture is removed when the infant leaves the recovery room.

Following palate surgery, the infant is placed in a prone or lateral position with the head dependent, turned to the side, and extended. This position can be achieved with a jack placed under the foot of the crib or by placing a bulky bath blanket under the hips of the infant. Any blood or mucus will accumulate in the dependent cheek or drain out of the mouth.

Following cleft lip surgery, a Logan bow is frequently used to take the tension off the newly sutured lip. The infant can still be placed in the lateral position. Elbow restraints are applied before leaving the operating room. A high-humidity atmosphere is recommended postoperatively to reduce the incidence of tracheitis, but benefit has not been clearly demonstrated.

References

• Cladis F, Grunwaldt L, Losee J. Anesthesia for Plastic Surgery. In: Davis PJ & Cladis FP, ed. Smith's Anesthesia for Infants and Children. 10th ed. Elsevier; 2021: 957-963.