METHODS : CASE REPORT:

CASE 1: 4 year old child with dextrocardia presenting for post alveolar cleft palate repair.

CASE 2: 2 year old child with porencephalic cyst presenting for cleft lip and palate repair.

CASE 3: 10 year old child presenting for limbaldermoid excision.

Anaesthesia induced by inhalation anaesthesia with O2 100% and sevoflurane (0.5-4%); airway secured with endotracheal intubation; maintained by using N2O/O2=50% and sevoflurane (1-2.5%).

Inhalation induction with sevoflurane was chosen, anticipating difficult airway and because sevoflurane provides better cardiac stability when compared to other inhalation agents in conditions of dextrocardia which was encountered in our first case. Ventilation was gradually assisted with increasing depths of anaesthesia and patients intubated by direct laryngoscopy. Muscle relaxant was given only after securing the airway. All antiepileptic precautions were taken in our second case which revealed porencephalic cyst on neurological imaging.

Inhalation technique of induction with the child breathing spontaneously should be the most important consideration in airway management of patients with Goldenhar syndrome. All cases should undergo thorough cardiac and neurological evaluations and the anaesthetic risks stratified preoperatively