Role of anesthesiologist in the management of a child with cerebral palsy

Abstract

Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Postoperative analgesia is important, particularly in orthopedic surgeries one for pain relief. This review highlights the clinical manifestations in CP and anesthetic considerations in such child presenting for various surgeries.

Regional anesthesia in pediatric patients with preexisting neurological disease

“…The majority of CP cases are caused by intrauterine insults, though other causes are known. Birth asphyxia, perinatal hypoxia, congenital malformations, intraventricular hemorrhage, and intrauterine infections have all been shown to cause CP 77 . There are four types of CP described by the Swedish classification system—spastic CP, dyskinetic CP, ataxic CP, and mixed.…”

“…Birth asphyxia, perinatal hypoxia, congenital malformations, intraventricular hemorrhage, and intrauterine infections have all been shown to cause CP. 77 There are four types of CP described by the Swedish classification system-spastic CP, dyskinetic CP, ataxic CP, and mixed. The type of CP and degree of disability is dependent on the area of the brain affected along with the severity of the neurologic injury.…”

“…Intellectual disability and neurosensory disturbances are present in two-thirds of patients. 77 The majority of CP cases are caused by intrauterine insults, though other causes are known. Birth asphyxia, perinatal hypoxia, congenital malformations, intraventricular hemorrhage, and intrauterine infections have all been shown to cause CP.…”

“…Cerebral palsy (CP) describes a group of heterogeneous, chronic, nonprogressive disorders of motor development in children. Intellectual disability and neurosensory disturbances are present in two‐thirds of patients 77 . The majority of CP cases are caused by intrauterine insults, though other causes are known.…”

Pain management in children with cerebral palsy undergoing reconstructive or palliative hip joint surgery

“…В настоящее время «золотым стандартом» обеспечения таких операций является сочетание ингаляционной анестезии с продленной нейроаксиальной блокадой, безопасность которой доказана целым рядом крупномасштабных исследований [13][14][15][16][17][18][19][20][21][22]. Вместе с тем до сих пор остается открытым вопрос о целесообразности применения этой методики у детей с эпилепсией, принимающих препараты вальпроевой кислоты, из-за потенциального риска геморрагических осложнений (эпидуральная гематома) [16,17,[23][24][25].…”