Use of cost-effective prophylactic 'Rocket' in infants undergoing primary cleft lip surgery: A retrospective cohort analysis

Renu Devaprasath, Nishal S Perumal, T Jeyanthan, Sunil Richardson

Astrocyte 2016 3(2):78-81

Background and Objectives: Adverse postoperative airway events are a significant problem in infants following primary cheiloplasty. This study aims to describe a simple inexpensive tool which, used prophylactically, can minimize postoperative airway obstruction (POAO). A retrospective cohort analysis was conducted among 314 infants who underwent primary cheiloplasty under general anesthesia at a hospital in Kanyakumari District in Tamil Nadu, India. Materials and Methods: The infants were divided into two cohorts, the first prior to introduction of the modified nasal airway (termed locally as "Rocket" due to its appearance once fixed in position), and the second after its use began in July 2007. The Rocket, consisting of an uncuffed endotracheal tube, 0.5 mm smaller in diameter than that used for intubation, was placed prophylactically prior to extubation in the nasal space of infants considered at risk. The incidence of POAO was compared between the two cohorts. Results: The incidence of POAO in cohort I (N = 86) was 8.1%, which reduced significantly to 0.44% in cohort II (N = 228) where the Rocket was used prophylactically prior to extubation. Interpretations and Conclusions: The prophylactic use of the Rocket minimized the occurrence of POAO following primary cheiloplasty in infants with cleft lip ± cleft palate ± cleft alveolus. The Rocket may be a costeffective solution to prevent POAO in infants undergoing these procedures, particularly in challenging and rural circumstances, where access to short-acting agents and customized airways may be limited.

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