KUMJ | VOL. 2 | NO. 2 | ISSUE 6 | APRIL-JUNE, 2004
Anaesthesia for cleft lip surgery – a challenge in rural Nepal
Maharjan SK
Abstract: Cleft lip and palate is quite common in Nepalese population residing in hilly areas and interior of the country.
Nepalese doctors with limited resources and fund and International aided team of fully equipped doctors from
developed world conduct operative procedures in the centre or district hospital setup quite frequently. But very few
patients will come to the hospital for treatment as it is not an emergency for them.
Anaesthesia for cleft lip and palate surgery carries a high risk and difficulty in airway management. Associated
congenital anomalies further complicate the management. Still a team of Nepalese physicians are providing this
service in a field. How to provide safe anaesthesia was a main concern for an anaesthesiologist with a limited
supply. During the last three years we have anaesthetized safely four hundred children aged between 2 months to 14
years. The team worked at an altitude ranging from 100 feet to 10,000 feet of Nepal in a temporary erected operation
room of the village. Most of the operations were conducted under total Ketamine anaesthesia and general
anaesthesia with halothane. In our context we found Ketamine anaesthesia was safe and effective anaesthetic
technique in simple clefts in children more than 2 years. This technique reduces the cost by minimizing the supply to
be carried in the field.
Keyword : cleft lip, cleft palate, ketamine, rural area, difficult intubation
