R. Goel, L. Bubb, K. Gillespie, J. Keough

Alder Hey Children's Hospital, UK

Introduction & Aims

Anaesthetic management of cleft surgery patients varies between centres and individual anaesthetists. Increasingly TIVA is becoming a popular choice of anaesthetic technique for a wide number of cases and procedures (1,2); especially within the cleft surgical subspeciality at our centre. We set out to assess what effect TIVA had compared to volatile anaesthesia on the outcomes of our patients undergoing a variety of cleft surgery in our tertiary paediatric hospital.


A total of 120 cases were identified during the study period of January 2023 and November 2023 whom had either cleft lip, cleft palate, cleft lip and palate, bone graft or pharyngoplasty surgery.  Cases were excluded if they had incomplete records; a total of 8 cases were removed for this reason. Therefore 112 cases had their anaesthetic management and subsequent post operative course examined retrospectively. The outcome measures we focused on were time to first oral intake, post operative length of stay and post op antiemetic use.


Table 1 shows how the TIVA patients compared to those receiving volatile. A two sample t-test was used for statistical analysis between the groups.

The average time to first oral intake in the TIVA group was 177.35 minutes (95% CI 152.16 – 202.54) compared to 249.92 minutes (95% CI 207.71 – 292.13) in the volatile group. The average length of stay was comparable between the 2 groups with TIVA patients averaging 1.13 days compared to 1.32 days in the volatile group. Only one patient in the TIVA group required post operative antiemetics compared to 8 in the volatile group.

We found that there was a statistically significant reduction in time to first oral intake and the number of patients requiring post operative antiemetics in the TIVA patients compared to those receiving volatile.


The results demonstrate that for nearly all types of cleft surgery, TIVA significantly reduced time to first oral intake and post operative antiemetic requirement. The average length of stay was similar between the 2 groups.

We acknowledge that this is a single centre retrospective study and that there is a need for a randomised control trial to further assess the difference between TIVA and volatile anaesthesia.



  1. Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth. 2020 Mar;30(3):209-220. doi: 10.1111/pan.13809. Epub 2020 Jan 27. PMID: 31886922.
  2. Riedel B, Dubowitz J, Yeung J, Jhanji S, Kheterpal S, Avidan MS. On the horns of a dilemma: choosing total intravenous anaesthesia or volatile anaesthesia. Br J Anaesth. 2022 Sep;129(3):284-289. doi: 10.1016/j.bja.2022.06.008. Epub 2022 Jul 11. PMID: 35835606.
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