Cerebral palsy: Anesthesia management

Advanced, Clinical Subspecialties

Cerebral Palsy represents a large spectrum of symptoms usually stemming from an injury to the developing brain which impairs various neurological functions and has wide ranging sequelae across many organ systems (e.g. mild monoplegia to spastic quadriplegia; normal cognition to severe MR). CP is often classified as spastic, dyskinetic, ataxic and mixed. Most commonly these patient undergo general anesthesia for imaging, neurosurgery (VP shunt), orthopedic surgery (hip spica, tenotomy, arthrodesis, fusion), dental extractions, and general surgery (GI, hernias)

Preoperative assessment should additionally focus on seizure type and history, spasticity, swallowing impairment/home suction needs/aspiration hx and risk, esophageal dysfunction, G-tube, scoliosis severity (c/f pulm htn), chronic lung disease, tracheostomy, cognitive/communication impairment, prior anesthetic needs/outcomes (difficult airway?). Also consider the implications of polypharmacy on your intra and post-operative medication management.

These patients have lower MAC due to anticonvulsant use. CP patients tend to have increased resistance of Non-Depolarizer

Most common intraoperative complications include hypothermia, hypotension, delayed emergence, seizure, obstruction, PNA, stridor, bronchospasm, neuropathy, reintubation, aspiration, and laryngospasm (with the first two categories encompassing the vast majority of complications).

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Answered correctly

2020

Year asked

Author
Justin Hickman, MD