Pediatric anesthesia & critical care
Quality Improvement Protocol to Reduce Excessive Postoperative Recovery Following Cleft Palate Repair
Authors' conclusion
The three components of this study combined to effectively reduce excessive PACU stay.
Study context
- Population
- Infants < 36 months undergoing primary cleft palate repair, March 2016–December 2024, tertiary centre
- Participants
- 434 infants
- Comparison
- Sequential Plan-Do-Study-Act (PDSA) phases: standardised multimodal analgesic protocol, selective above-elbow arm splints, intraoperative dexmedetomidine
- Outcome
- Mean PACU LOS
Methodological detailsmultidisciplinary, iterative PDSA cycles
- Multidisciplinary
- Iterative PDSA cycles
Main finding
As reported in the abstract
Mean PACU stay
Reduction in mean post-anesthetic care unit (PACU) stay with anesthetic standardization
16%
Reduction in PACU stay with splint rationalization
15%
Reduction in PACU stay with intraoperative dexmedetomidine
11%
Secondary outcomes
Pain or distress requiring opiate intervention
- Pain or distress requiring opiate intervention — Overall incidence
- 31%
Pain or distress requiring opiate intervention
- No significant reductions in incidence
Safety
- Perioperative adverse respiratory event · first hour post-surgery — Dexmedetomidine
- 12%
- Perioperative adverse respiratory event — Overall incidence
- 23%
Perioperative adverse respiratory event · first hour post-surgery
- Significant reduction in dexmedetomidine phase; non-significant decreases in other phases
Unexpected PICU intervention
- Reduced from 7.3% to 1.2%
- Significant reductions in splint and dexmedetomidine phases
Original publication
Quality Improvement Protocol to Reduce Excessive Postoperative Recovery Following Cleft Palate Repair. Paediatr Anaesth. Published 24 July 2025. doi:10.
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