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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.
Cerebral palsy (CP) is a common cause of morbidity and disability in childhood. CP is a heterogeneous group of chronic nonprogressive disorders of motor development and posture in children that are associated with cognitive and neurosensory disturbances.[1,2]
Most cases of CP arise from intrauterine – antepartum causes. Birth asphyxia, perinatal ischemia and hypoxia, congenital malformations, intraventricular hemorrhages, intrauterine infections – all contribute to the development of CP.[4,5,6,7,8,9,10,11,12]
A child with CP can present for surgery, and anesthetic management is challenging because of the involvement of various organ systems and associated complications. Central nervous system is often involved, and they can present with varying degrees of movement disorders as described below.
Spastic CP (70%):
Dyskinetic CP (10%):
Ataxic CP (10%):
Children with CP can present for many interventional diagnostic and surgical procedures. A detailed knowledge of these procedures is essential for the treating anesthesiologist. Commonly performed surgical interventions in these children include:
The management of CP is multimodal one. The treatment in these cases demands a team therapy by psychotherapy, physiotherapy, medical, and surgical approaches. Considering the ethical aspects, the primary goal of such specialized care is mainly to improve the quality of life and the quality of care. Anesthesiologist comes into picture during the perioperative management, in high-dependency care and intensive care as well as pain management. Recent advances in treatment modalities and surgical techniques along with improved postoperative care have significantly reduced the morbidity. A successful management in CP is done by a team of experienced specialists as well as psychological support by caregivers.
There are no conflicts of interest.