Anesthesia for Children with Cerebral Palsy

Abstract

Cerebral Palsy (CP) is the most common movement disorder in children with world-wide prevalence estimated to be between 1.5 and 4 per 1000 live births. One U.S. surveillance study of children from birth to age 8 found the rate of CP to be 3.1 per 1000 (Christensen et al., Dev Med Child Neurol 56(1):59–65, 2014; Rosenbaum et al., Dev Med Child Neurol Suppl 109:8–14, 2007) indicating approximately 1/300 children in the U.S. have CP. Although the prevalence of CP appears to have remained constant over the last 20 years, a 2016 Cochrane review suggests that due to newer neonatal interventions and advances in obstetrical care, the incidence and severity of CP may be decreasing (Shepherd et al., Cochrane Database Syst Rev (10):1–12, 2016). Nevertheless, patients with CP are still commonly encountered in anesthesia practice. With the myriad of treatments and surgical interventions presently available these patients, particularly children, are frequently exposed to anesthesia and carry significant perioperative risks—as high as 63.1% according to a recent study (Wass et al., J Child Neurol 27(7):859–66, 2012). This chapter will focus on important perioperative considerations during the care of a pediatric patient with CP. Table 45.1 provides a summary of anesthesia considerations in children with Cerebral palsy.