Airway management and anaesthetic interventions for children with cleft lip and/or palate undergoing general anaesthesia: Protocol for a systematic review and meta-analysis

Methods

This systematic review and meta-analysis will include randomised controlled trials involving children < 18 years with cleft lip and/or palate undergoing general anaesthesia. Eligible studies will compare alternative techniques or devices for airway management or other anaesthetic strategies between two groups of cleft lip/palate patients. The primary outcome will be difficulty in tracheal intubation. Where definitions vary substantially, outcomes will be analysed separately or synthesised narratively. Secondary outcomes will include difficult mask ventilation, oxygen desaturation, airway obstruction, difficult laryngoscopy, first-attempt intubation success, number of intubation attempts, time to successful intubation or airway establishment, failed intubation and other perioperative airway or respiratory adverse events. Two reviewers will independently select RCTs, extract data and assess risk of bias. Risk of bias will be evaluated using the Cochrane Risk of Bias 2 tool. Random-effects meta-analysis will be performed where clinically appropriate. Risk ratios will be used for dichotomous outcomes and mean differences or standardized mean differences for continuous outcomes. Certainty of evidence for important outcomes will be assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.