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CEREBRAL PALSY AND ANESTHESIA

WHAT IS CEREBRAL PALSY?. Disorder of posture and movementPermanent and non-progressive brain damageMany different causesClinical picture changes over time /- associated abnormalities2

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CEREBRAL PALSY AND ANESTHESIA

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    2. WHAT IS CEREBRAL PALSY? Disorder of posture and movement Permanent and non-progressive brain damage Many different causes Clinical picture changes over time +/- associated abnormalities 2 – 7 per 1000 live births

    3. CAUSES OF CEREBRAL PALSY

    5. CLASSIFICATION OF CP Spastic Dyskinetic Ataxic Mixed

    6. CLASSIFICATION OF CP

    10. CLASSIFICATION OF CP

    11. CLASSIFICATION OF CP

    13. Pre-op Assessment and Planning Communication and level of functioning Associated medical conditions Current drug therapy Post-op analgesia

    14. PRE-OP ASSESSMENT GASTROINTESTINAL Gastroesophageal Reflux Disease (GERD) Common (50%) Non-specific symptoms (vomiting, hematemesis, rumination, food refusal, rec. pneumonias, failure to thrive, behavioral problems, dental erosions, dystonic posture) Treated on PPIs Salivary drooling May be on anticholinergics Poor nutritional state Check electrolytes and Hb

    15. PRE-OP ASSESSMENT RESPIRATORY Chronic aspiration ~ recurrent chest infections Scoliosis ~ restrictive lung disease Difficult to assess May need physical therapy, bronchodilators, antibiotics and an ICU bed

    16. PRE-OP ASSESSMENT AIRWAY Loose teeth TMJ dysfunction Malocclusions Drooling EPILEPSY (30%) Continue anticonvulsants on day of surgery

    17. PRE-OP ASSESSMENT VISUAL DEFECTS (40%) Myopia, field defects, blindness, strabismus BEHAVIOUR & COMMUNICATION Intellectual deficit (2/3) Emotional problems Depression

    18. DRUGS IN CP

    21. PERI-OP MANAGEMENT Parent present at induction and recovery Problems: vascular access airway maintenance airway protection positioning hypothermia Age–appropriate ETT Anti-emetic prophylaxis Regional and local blocks if possible

    22. ANESTHETIC DRUGS Sux can be used Resistance to NDMR Underestimate block on TOF Reduced MAC Avoid Enflurane, Etomidate, Ketamine, and Methohexital

    23. POST-OP MANAGEMENT Problems: Delayed emergence Irritability on emergence Airway protection Positioning Chest infections Chronic medication Anticonvulsants Antispasmodics Avoid baclofen withdrawal

    24. PAIN MANAGEMENT Assessing pain may be tricky No pain scale Behavioral markers unreliable Parents know! Parent- / Nurse-controlled Analgesia Spasms Pre-op Botox Epidural Diazepam Rectal Acetaminophen

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