A protocol for safe anaesthesia for cleft lip and palate surgery in developing countries

A project to perform surgical correction of cleft lips and palates was carried out in Uganda in 1998. Twenty centres were visited and 336 cleft lips and 41 cleft palates were repaired. The age of the patients ranged from 2 weeks to 60 years. Many of the centres visited were remote and lacked even the most basic equipment. Patients were anaesthetised using ketamine, ether or halothane according to a protocol that we developed. There was no anaesthetic mortality and only one case of significant morbidity. We report our experience and discuss recommendations regarding the provision of anaesthesia in remote circumtances based on our outcome. An additional benefit of the project was that we provided training to local medical personnel in anaesthesia and surgery for cleft lips and palates.