Correspondence

4 Rubin AD, Hawkshaw MJ, Moyer CA et al. Arytenoid cartilage dislocation: a 20-year experience. J Voice 2005; 19: 687–701.

5 Sataloff RT, Bough ID Jr, Spiegel JR. Arytenoid dislocation: diagnosis and treat-

ment. Laryngoscope 1994; 104(11 Pt 1): 1353–1361.

Survey of analgesia for cleft lip and palate repair in the UK and Republic of Ireland SIR—Cleft lip and palate (CLP) surgery is painful requiring long-acting analgesia with minimal respiratory depression. At the Royal Manchester Children’s Hospital, our analgesia protocol comprises intraoperative paracetamol, remifentanil, dexamethasone, and postoperative regular paracetamol with ‘as required’ ibuprofen and morphine. We considered introducing a ‘nonstandard’ analgesic (clonidine) and so wondered what regimes are followed elsewhere, particularly in the light that the evidence base supporting analgesic efficacy in this group of patients is poor (1). We surveyed anesthetists in the 19 CLP centers in the UK and Ireland and had a response rate of 79%. The median estimated number of CLP surgeries performed annually in these centers was 120, and most centers have >3 regular CLP anesthetists. Our results indicated that 40% of centers used a protocol-based CLP perioperative analgesia, with only one center using preoperative analgesia and six centers using intraoperative infraorbital block (if appropriate); this is despite the APA recommendation for an IOB in all cleft lip repairs. All centers use intraoperative and regular postoperative paracetamol, and all use a nonsteroidal postoperatively. Opiates are largely prescribed on an ‘as required’ prescription with two centers using postoperative opiate infusions. We were the only center to use intraoperative remifentanil, and only one center uses clonidine.

Our practice is currently similar to most except our use of remifentanil. In light of these findings, we reaudited our current regime and found that although pain was well controlled overall, we only used infraorbital block in 25% of CL repairs; most of which did not need postoperative opiates. We are now focusing on improving our use of IOB prior to considering adding a ‘nonstandard’ analgesic. When responding to the survey, several CLP units commented that they are planning on auditing CLP analgesia in the future. Perhaps a national audit would direct us to the optimum analgesia regime and provide a template to develop national guidelines and standards for analgesia in this group of patients. Acknowledgment No ethical approval needed. This research was carried out without funding. Conflict of interest No conflicts of interest declared. Hilary A. Eason, Russell Perkins & Moataz Abdelrahman Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Central Manchester Foundation Trust, Manchester, UK Email: [email protected] doi:10.1111/pan.12302

Reference 1 Association of Paediatric Anaesthetists. Good practice in postoperative and

procedural pain. [Internet]. 2008. Available at: http://www.britishpainsociety.

org/book_apa_part1.pdf. Accessed 12 March, 2012.

Anesthetic implications of infants with mandibular hypoplasia treated with mandibular distraction osteogenesis SIR—With great interest, we have read the article by Frawley et al. (1). This manuscript is a valuable contribution to the present knowledge about the anesthetic © 2014 John Wiley & Sons Ltd Pediatric Anesthesia 24 (2014) 224–231

implications of infants with mandibular hypoplasia and the positive effect of mandibular distraction on airway management during later intubations. However, there 227

Survey of analgesia for cleft lip and palate repair in the UK and Republic of Ireland.

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