Anaesthesia management for cleft lip in a child with unrepaired Tetralogy of Fallot in Malawi: a case report

Furaha Nzanzu Blaise Pascal^1,2, Beauty Anusa¹, Stella Chikumbanje^1,3,4, Gregor Pollach⁴

1. Mercy James Centre for Paediatric Surgery and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi.
2. Faculty of Medicine, Univesité Catholique du Graben de Butembo, Democratic Republic of Congo.
3. Department of Anaesthesia and Intensive Care, Queen Elizabeth Central Hospital, Blantyre, Malawi
4. Department of Anaesthesia and Intensive Care, Kamuzu University of Health Sciences, Blantyre, Malawi
   *Corresponding Authors: Furaha N Blaise Pascal; E-mail: blaisepascal.furaha@gmail.com

Abstract
Background
Children with clefts lips often present with cardiac abnormalities, among them the tetralogy of Fallot. Anaesthesia for patients with unrepaired Tetralogy of Fallot coming for a non-cardiac surgery represents an additional risk of increased perioperative morbidity and mortality.
Case presentation
We present a case of a 8 years old boy with unrepaired Tetralogy of Fallot scheduled for cleft lip repair. The Child was referred to Mercy James Centre for Paediatric Surgery and Intensive Care from an Operation Smile Mission campaign. Anaesthesia consisted of a balanced general anaesthesia combined with regional anaesthesia by an infraorbital nerve block. The child developed hypercyanotic spells postoperatively which were successfully managed with noradrenaline, morphine, fluid, and oxygen therapy.
Conclusion
Children with unrepair Tetralogy of Fallot coming for non-cardiac surgery have increased risk of complications during anaesthesia. The anaesthesia provider should be aware and ready to manage them promptly.

Key words: Anaesthesia, cleft lip, Tetralogy of Fallot, hypercyanotic spell, Malawi