Cerebral Palsy (CP) 

 

 

Background 

 

  • A disorder of movement & posture due to a static encephalopathy

  • Huge spectrum of presentation: almost asymptomatic to completely dependent 

  • Caused by a cerebral insult in the immature brain that occurred prenatally, perinatally, or during infancy

  • The motor deficit may manifest as:

    • Hypotonia

    • Spasticity

    • Extrapyramidal features such as choreoathetoid/dystonic movements or ataxia

 

 

Considerations

 

  • ↓ C-spine mobility & possible difficult intubation

  • Aspiration risk (GERD/↓lower esophageal sphincter tone)

  • Pulmonary:

    • Recurrent aspiration & pulmonary impairment

    • Scoliosis & ↑ bleeding risk during scoliosis surgery

    • Rule out pulmonary HTN/RV failure 

  • CNS:

    • Developmental delay/lack of cooperation

    • Seizure d/o

    • Hydrocephalus 

  • Altered response to anesthetics:

    • ↓ MAC of volatiles & longer emergence 

    • ↑ sensitivity to muscle relaxants   

    • Volatiles & succinylcholine NOT contraindicated

  • Difficult IV access, monitoring, & positioning due to contractures 

  • Ex-premature conditions 

  • ↑ risk of hypothermia

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