Airway management for oral surgery in a patient with repaired cleft palate
Bibliographic record
Abstract
Sir, Sharing airway with surgeon is always challenging for anesthesiologist. However, the preexisting airway defect would certainly add more problems to it. Here, we have highlighted such an issue in patient with preexisting palatal defect who was posted for oral surgery. Otherwise healthy female was diagnosed as a case of benign growth of tongue and scheduled for wide local excision of right lateral border of tongue. She had been operated for repair of cleft palate at the age of 18 month and still had a peanut size defect in the midline of soft palate. There was neither an associated upper respiratory tract infection (URTI) nor airway obstruction like symptoms. Surgical procedure required nasal intubation for the case; however, in view of existing soft palate defect, a decisive dilemma emerged regarding the management of airway. Standard monitors were attached. After standard anesthetic induction, nasal intubation was carefully performed through left nostril and trachea was intubated with 7.5 mm flexomettalic tube under fibreoptic bronchoscopy (FOB). A Ryle's tube was also inserted under Glidoscope view without causing injury to soft palate. Rest of the intraoperative course was uneventful and at the completion of surgery, trachea was extubated. The patient was shifted to postoperative recovery unit. In general, nasal intubation is not advocated in patients with previous cleft palate surgery in childhood and even if it is required then it has to done on the opposite side of defect.[12] Since the defect is in midline in our case and nasal intubation was required, we opted for intubation using FOB. The alternate method of intubation is also described in the literature.[2] The anatomy of the nasopharynx as well as oropharynx usually gets altered after the cleft palate repair and increases the difficulty during nasotracheal intubation.[3] It also carries a risk of damage to the repaired palatal defect. Although considered being a gold standard, FOB has its own limitations in such conditions. It requires the expertise to assess the size of the nasopharyngeal ports and passing the scope into the oropharynx without further traumatizing the nasopharyngeal structures. Moreover, in conditions with secretions and bleeding, it becomes difficult to visualize by FOB. In summary, airway management in patients with previous cleft palate surgery will always be a challenge for the anesthesiologist and will influence the method of airway control. Thorough preoperative assessment to rule out persisting palatal defect coupled with judicious implementation of knowledge and skill is needed to avert the unwanted complication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.007 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".