Safety and Outcomes of Anaesthesia for Cleft Lip and Palate Surgery in Sub-Saharan Africa: A Prospective Cross‑Sectional Study of 415 Children at Garoua Regional Hospital, Cameroon
Sécurité et Résultats de l’Anesthésie pour Chirurgie des Fentes Labio-Palatines en Afrique Subsaharienne : Une Étude Transversale Prospective de 415 Enfants à l’Hôpital Régional de Garoua, Cameroun
Keywords:
Cleft lip and palate, Paediatric anaesthesia, halothane, propofol, Northern CameroonAbstract
ABSTRACT
Introduction. Cleft lip and palate (CLP) is a common congenital anomaly, but epidemiological and perioperative data from sub‑Saharan Africa remain scarce. This study aimed to evaluate the anaesthetic management of children with CLP undergoing corrective surgery in Garoua, Cameroon, and to identify opportunities for improvement. Patients and Methods. This was a prospective, descriptive cross sectional study. It was a 5 year period between December 2019 to December 2024 on all complete and legible anaesthetic records of patients with CLP operated during free surgical campaigns and scheduled programmes at the GRH, including satellite outreach facilities. Results. A total of 415 patients were included. Males predominated (53%; sex ratio 1.13). The most represented age group was 3–12 months (49.9%). Rural origin was documented in 46.4% of patients. Family history of CLP was present in 24.6% of cases. Unilateral cleft lip was the most frequent cleft type (71.5%). ASA class I accounted for 98.6% of patients. General anaesthesia with orotracheal intubation was used in 90.2% of cases. Propofol was the primary induction agent (98.3%); halothane was the maintenance agent in 92.4% of cases. Intraoperative complications occurred in 5 patients (1.2%): tachycardia (n=3) and hypotension (n=2), all resolved without sequelae. Postoperative hospitalisation lasted 24 hours in 56.6% of patients. No mortality was recorded. Conclusion. Anaesthetic management of CLP in this resource-limited setting proved safe, with a low intraoperative complication rate and zero mortality. Priority areas for improvement include provision of modern anaesthetic agents and creation of a dedicated post-anaesthesia care unit.
RESUME
Introduction. Les fentes labio-palatines (FLP) sont des malformations congénitales fréquentes, mais les données épidémiologiques et périopératoires en Afrique subsaharienne restent rares. Notre étude avait pour but d’évaluer la prise en charge anesthésique des enfants opérés d’une FLP à Garoua, au Cameroun, et à identifier des axes d’amélioration. Patients et méthodes. Il s'agit d'une étude prospective, descriptive et transversale. Elle a porté sur une période de 5 ans, de décembre 2019 à décembre 2024. Nous avons inclus tous les dossiers anesthésiques complets et lisibles des patients atteints de FSP opérés lors de campagnes chirurgicales gratuites et de programmes programmés au GRH, y compris dans les structures satellites. Résultats. Au total, 415 patients ont été inclus. Les hommes étaient majoritaires (53 %; rapport hommes/femmes de 1,13). La tranche d’âge la plus représentée était celle des 3 à 12 mois (49,9 %). Une origine rurale a été signalée chez 46,4 % des patients. Des antécédents familiaux de fente labiale et palatine étaient présents dans 24,6 % des cas. La fente labiale unilatérale était le type de fente le plus fréquent (71,5 %). La classe ASA I représentait 98,6 % des patients. Une anesthésie générale avec intubation orotrachéale a été pratiquée dans 90,2 % des cas. Le propofol était l'agent d'induction principal (98,3 %) ; l'halothane était l'agent d'entretien dans 92,4 % des cas. Des complications peropératoires sont survenues chez 5 patients (1,2 %) : tachycardie (n = 3) et hypotension (n = 2), toutes résolues sans séquelles. L'hospitalisation postopératoire a duré 24 heures chez 56,6 % des patients. Aucun décès n’a été enregistré. Conclusion. La prise en charge anesthésique de la CLP dans ce contexte aux ressources limitées s’est avérée sûre, avec un faible taux de complications peropératoires et une mortalité nulle. Les domaines prioritaires à améliorer comprennent la mise à disposition d’agents anesthésiques modernes et la création d’une unité de soins post-anesthésiques dédiée.
References
1. Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, et al. National population-based estimates for major birth defects, 2010–2014. Birth Defects Res. 2019;111(18):1420–1435. doi:10.1002/bdr2.1589.
2. World Health Organization, Regional Office for Africa. Surveillance of congenital malformations in sub-Saharan Africa: current situation and prospects. Brazzaville: WHO Africa; 2018.
3. Longombe AO, John PM, Etienne V. Anaesthesia for cleft lip and palate surgery in resource-limited settings: review and perspectives. Ann Fr Anesth Reanim. 2013;32(Suppl 1):A156–A157.
4. Dadure C, Capdevila X. Anaesthetic management for cleft lip and palate surgery in children. Le Praticien en Anesthésie Réanimation. 2011;15(3):206–210. doi:10.1016/j.pratan.2011.05.008.
5. Donamou J, Touré A, Camara Amadou Y, Traoré A, Awoumou Eddyane OS, Camara M’mah L, et al. Anaesthesia for cleft lip and palate surgery: experience of the Donka National Hospital, Conakry. Rev Afr Anesth Med Urgence. 2020;25(1):67–71.
6. Sié Essoh JB, Ouattara O, N’guessan YF, Yapo-Ehounoud C, Tetchi YD, Kakou-Guikahue M. Anaesthesia for cleft lip and palate surgery: experience at the Treichville University Hospital, Abidjan. Rev Afr Anesth Med Urgence. 2015;20(2):45–49.
7. World Health Organization. Management of birth defects and haemoglobin disorders: report of a joint WHO-March of Dimes meeting, Geneva, Switzerland, 17–19 May 2006. Geneva: WHO; 2006.
8. Mossey PA, Little J, Munger RG, Dixon MJ, Shaw WC. Cleft lip and palate. Lancet. 2009;374(9703):1773–1785. doi:10.1016/S0140-6736(09)60695-4.
9. Butali A, Suzuki S, Cooper ME, Mansilla MA, Cuenco K, Leslie EJ, et al. Replication of genome-wide association identified candidate genes confirm the role of common and rare variants in PAX7 and VAX1 in the aetiology of non-syndromic CL/P. Am J Med Genet A. 2013;161A(5):965–972. doi:10.1002/ajmg.a.35834.
10. Abadie V. Management of cleft lip and palate. Arch Pediatr. 2002;9(12):1274–1284. doi:10.1016/S0929-693X(02)00086-4.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Bilogui Adjessa Willy, Ngono Ateba Glwadys, Njall Pouth Clotilde, Ndom Ntock Ferdinand, Ndengue Raissa, Jim Nemy Hervé, Issaka Sali, Ngandji Issah, Nenkam Ebénézer, Adamson Phiri, Metogo Mbengono Junette
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC BY-NC-ND 4.0 that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
