Department of Otolaryngology-Head and Neck Surgery, Laval University, Quebec, QC.
J Otolaryngol Head Neck Surg. 2011 Oct;40(5):413-9.
To find predictors of a difficult intubation in infants with an isolated or a syndromic cleft lip/palate.
Retrospective review: single-blind trial.
Tertiary care centre.
A total of 145 infants born with cleft lip/palate were enrolled. Three clinical and seven lip/palate anatomic parameters were evaluated. The grade of intubation was determined by the anesthesiologist at the time of the labioplasty/staphylorrhaphy surgery at 3 and 10 months, respectively.
Intubation grade.
The relative risk of a difficult intubation in the cleft lip, cleft palate without the Pierre Robin sequence, cleft lip-palate, and cleft palate with Pierre Robin sequence groups was 0, 2.7, 10, and 23%, respectively. The infants born with the Pierre Robin sequence had a statistically significant higher intubation grade. The degree of difficulty was increased in cases with early airway and feeding problems (p < .0001). Within the group of cleft palate patients without any lip malformation, a wider cleft was associated with a higher intubation grade with statistical significance (p = .0323).
Infants born with Pierre Robin sequence have a statistically significantly higher risk of difficult intubation. Within this group, of all the studied factors, a clinical history of early airway and feeding problems was the best predictor of a difficult endotracheal intubation. In cleft palate patients without any cleft lip, larger width of the cleft is also a significant predictor.
探讨单纯唇裂/腭裂和综合征性唇裂/腭裂婴儿中，预测插管困难的相关因素。
回顾性研究：单盲试验。
三级医疗中心。
共纳入 145 例唇裂/腭裂婴儿。评估了 3 项临床参数和 7 项唇/腭解剖参数。在唇裂整复术/鼻牙槽嵴裂植骨术时，麻醉医生对插管等级进行评估，分别在 3 个月和 10 个月进行。
插管等级。
单纯唇裂、无 Pierre Robin 序列的完全性腭裂、唇裂合并腭裂、Pierre Robin 序列合并腭裂组的插管困难相对风险分别为 0、2.7、10 和 23%。Pierre Robin 序列患儿的插管等级具有统计学意义的显著升高。具有早期气道和喂养问题的患儿，其插管难度增加（p<0.0001）。在无任何唇畸形的腭裂患儿中，腭裂较宽与插管等级升高显著相关（p=0.0323）。
Pierre Robin 序列患儿插管困难的风险显著增加。在该组中，在所有研究因素中，早期气道和喂养问题的临床病史是预测困难性气管插管的最佳指标。在无任何唇裂的腭裂患儿中，腭裂较宽也是一个显著的预测因素。
