Evidence-Based Pediatric Anesthesia for Humanitarian Cleft and Maxillofacial Surgery: A Standardized Perioperative Protocol

Providing safe pediatric anesthesia during humanitarian cleft and maxillofacial surgery is particularly challenging because evidence-based perioperative care must be adapted to resource-limited environments while maintaining internationally recognized standards of patient safety. This educational review synthesizes current evidence across the major phases of pediatric perioperative anesthesia, including patient selection, fasting, airway management, regional and multimodal analgesia, fluid therapy, intraoperative monitoring, emergence, and postoperative care. International clinical practice guidelines, consensus statements, reviews, and relevant clinical studies were critically considered alongside multidisciplinary humanitarian experience. Based on this synthesis, current evidence was translated into an evidence-informed standardized perioperative protocol specifically designed for humanitarian cleft and maxillofacial surgery in low-resource settings. The proposed framework integrates structured perioperative assessment, individualized airway and extubation strategies, multimodal analgesia, appropriate physiological monitoring, multidisciplinary communication, and adaptation to locally available resources. Rather than replacing existing international recommendations, the protocol aims to facilitate their practical implementation through a reproducible and adaptable perioperative pathway. This framework may support greater consistency and safety in pediatric anesthesia delivery during humanitarian surgical missions while providing a basis for education, quality improvement, and future research. Prospective validation is required to assess its feasibility, adherence, clinical outcomes, and acceptability across different humanitarian settings.