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Anesthesia in the Child with Cerebral Palsy

  • Dinesh K. ChoudhryEmail author
  • Mary C. Theroux
Living reference work entry

Abstract

Cerebral palsy (CP) is a nonspecific, descriptive term that encompasses a constellation of symptoms due to neurologic lesion resulting from the insult to the developing brain sustained early in life. Although the neurologic lesion in CP is nonprogressive, the motor dysfunction due to spasticity may be progressive leading to spinal deformities, joint contractures, and dislocations requiring medical and surgical interventions. Anesthetic care for children with cerebral palsy is fraught with significant concerns for anesthesia provider and careful attention to all aspects of perioperative care is necessary. Perioperative planning and care should include thorough preoperative assessment, attention to co-morbidities, management of chronic medications, meticulous intraoperative care to maintaining normothermia, and adequate replacement of fluid and blood products. Postoperative assessment of pain and its management are essential to facilitate recovery and uneventful perioperative course.

Keywords

Cerebral palsy Hypothermia Coagulopathy Seizures Spine fusion 

References

  1. Albright AL (1996a) Baclofen in the treatment of cerebral palsy. J Child Neurol 11:77–83CrossRefGoogle Scholar
  2. Albright AL (1996b) Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol 11(Suppl 1):S29–S35CrossRefGoogle Scholar
  3. Albright AL, Ferson SS (2006) Intrathecal baclofen therapy in children. Neurosurg Focus 21:e3CrossRefGoogle Scholar
  4. Albright AL, Turner M, Pattisapu JV (2006) Best-practice surgical techniques for intrathecal baclofen therapy. J Neurosurg 104:233–239CrossRefGoogle Scholar
  5. American Society of Anesthesiologists Task Force on Perioperative Visual Loss (2012) Practice advisory for perioperative visual loss associated with spine surgery: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Visual Loss. Anesthesiology 116:274–285CrossRefGoogle Scholar
  6. Awan WA, Masood T (2016) Role of stretching exercises in the management of constipation in spastic cerebral palsy. J Ayub Med Coll Abbottabad 28:798–801PubMedGoogle Scholar
  7. Bax MC (1964) Terminology and classification of cerebral palsy. Dev Med Child Neurol 6:295–297CrossRefGoogle Scholar
  8. Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47:571–576CrossRefGoogle Scholar
  9. Bayhan IA, Sees JP, Nishnianidze T, Rogers KJ, Miller F (2016) Infection as a complication of intrathecal baclofen treatment in children with cerebral palsy. J Pediatr Orthop 36:305–309CrossRefGoogle Scholar
  10. Blackmore AM, Bear N, Blair E, Gibson N, Jalla C, Langdon K, Moshovis L, Steer K, WILSON AC (2016) Factors associated with respiratory illness in children and young adults with cerebral palsy. J Pediatr 168:151.e1–157.e1CrossRefGoogle Scholar
  11. Breakey AS (1955) Ocular findings in cerebral palsy. AMA Arch Ophthalmol 53:852–856CrossRefGoogle Scholar
  12. Brenn BR, Theroux MC, Dabney KW, Miller F (2004) Clotting parameters and thromboelastography in children with neuromuscular and idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976) 29:E310–E314CrossRefGoogle Scholar
  13. Brunstrom JE (2001) Clinical considerations in cerebral palsy and spasticity. J Child Neurol 16:10–15CrossRefGoogle Scholar
  14. Butler C, Campbell S (2000) Evidence of the effects of intrathecal baclofen for spastic and dystonic cerebral palsy. AACPDM Treatment Outcomes Committee Review Panel. Dev Med Child Neurol 42:634–645CrossRefGoogle Scholar
  15. Chalam KV, Tillis T, Syed F, Agarwal S, Brar VS (2008) Acute bilateral simultaneous angle closure glaucoma after topiramate administration: a case report. J Med Case Reports 2:1CrossRefGoogle Scholar
  16. Choudhry DK, Brenn BR (2002) Bispectral index monitoring: a comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg 95:1582–1585, table of contentsCrossRefGoogle Scholar
  17. Cladis FP, Grunwaldt L, Losee J (2011) Anesthesia for pediatric surgery. In: Davis PJ, Cladis FP, Motoyama EK (eds) Smith’s anesthesia for infants and children, 8th edn. Elsevier, PhiladelphiaGoogle Scholar
  18. Czyz CN, Clark CM, Justice JD, Pokabla MJ, Weber PA (2014) Delayed topiramate-induced bilateral angle-closure glaucoma. J Glaucoma 23(8):577–8CrossRefGoogle Scholar
  19. Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, Mclaughlin J, Morrison LA, Shrader MW, Tilton A, Vargus-Adams J (2010) Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology 74:336–343CrossRefGoogle Scholar
  20. Dhawale AA, Karatas AF, Holmes L, Rogers KJ, Dabney KW, Miller F (2013) Long-term outcome of reconstruction of the hip in young children with cerebral palsy. Bone Joint J 95-B:259–265CrossRefGoogle Scholar
  21. Dhuper S, Ehlers KH, Fatica NS, Myridakis DJ, Klein AA, Friedman DM, Levine DB (1997) Incidence and risk factors for mitral valve prolapse in severe adolescent idiopathic scoliosis. Pediatr Cardiol 18:425–428CrossRefGoogle Scholar
  22. Dicindio S, Theroux M, Shah S, Miller F, Dabney K, Brislin RP, Schwartz D (2003) Multimodality monitoring of transcranial electric motor and somatosensory-evoked potentials during surgical correction of spinal deformity in patients with cerebral palsy and other neuromuscular disorders. Spine (Phila Pa 1976) 28:1851–1855. discussion 1855-6CrossRefGoogle Scholar
  23. Dickerson RN, Brown RO, Hanna DL, Williams JE (2003) Energy requirements of non-ambulatory, tube-fed adult patients with cerebral palsy and chronic hypothermia. Nutrition 19:741–746CrossRefGoogle Scholar
  24. Dickey MP, Rice M, Kinnett DG, Lambert R, Donauer S, Gerber MA, Staat MA (2013) Infectious complications of intrathecal baclofen pump devices in a pediatric population. Pediatr Infect Dis J 32:715–722CrossRefGoogle Scholar
  25. Eicher PS, Batshaw ML (1993) Cerebral palsy. Pediatr Clin North Am 40:537–551CrossRefGoogle Scholar
  26. Evans PM, Evans SJ, Alberman E (1990) Cerebral palsy: why we must plan for survival. Arch Dis Child 65:1329–1333CrossRefGoogle Scholar
  27. Frei FJ, Haemmerle MH, Brunner R, Kern C (1997) Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation. Anaesthesia 52:1056–1060CrossRefGoogle Scholar
  28. Fung DL, White DA, Jones BR, Gronert GA (1991) The onset of disuse-related potassium efflux to succinylcholine. Anesthesiology 75:650–653CrossRefGoogle Scholar
  29. Gilmartin R, Bruce D, Storrs BB, Abbott R, Krach L, Ward J, Bloom K, Brooks WH, Johnson DL, Madsen JR, Mclaughlin JF, Nadell J (2000) Intrathecal baclofen for management of spastic cerebral palsy: multicenter trial. J Child Neurol 15:71–77CrossRefGoogle Scholar
  30. Goldstein EM (2001) Spasticity management: an overview. J Child Neurol 16:16–23CrossRefGoogle Scholar
  31. Gorges M, West NC, Cheung W, Zhou G, Miyanji F, Whyte SD (2016) Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery-a retrospective cohort study. Paediatr Anaesth 26:866–875CrossRefGoogle Scholar
  32. Gracies JM, Nance P, Elovic E, Mcguire J, Simpson DM (1997) Traditional pharmacological treatments for spasticity. Part II: general and regional treatments. Muscle Nerve Suppl 6:S92–S120CrossRefGoogle Scholar
  33. Gronert GA, Theye RA (1974) Effect of succinylcholine on skeletal muscle with immobilization atrophy. Anesthesiology 40:268–271CrossRefGoogle Scholar
  34. Gronert GA, Theye RA (1975) Pathophysiology of hyperkalemia induced by succinylcholine. Anesthesiology 43:89–99CrossRefGoogle Scholar
  35. Guest JD, Vanni S, Silbert L (2004) Mild hypothermia, blood loss and complications in elective spinal surgery. Spine J 4:130–137CrossRefGoogle Scholar
  36. Hepaguslar H, Ozzeybek D, Elar Z (1999) The effect of cerebral palsy on the action of vecuronium with or without anticonvulsants. Anaesthesia 54(6):593CrossRefGoogle Scholar
  37. Hirschfeld SS, Rudner C, Nash CL Jr, Nussbaum E, Brower EM (1982) Incidence of mitral valve prolapse in adolescent scoliosis and thoracic hypokyphosis. Pediatrics 70:451–454PubMedGoogle Scholar
  38. Ho JD, Keller JJ, Tsai CY, Liou SW, Chang CJ, Lin HC (2013) Topiramate use and the risk of glaucoma development: a population-based follow-up study. Am J Ophthalmol 155:336.e1–341.e1CrossRefGoogle Scholar
  39. Howard CB, Mckibbin B, Williams LA, Mackie I (1985) Factors affecting the incidence of hip dislocation in cerebral palsy. J Bone Joint Surg Br 67:530–532CrossRefGoogle Scholar
  40. Imrie MN, Yaszay B (2010) Management of spinal deformity in cerebral palsy. Orthop Clin North Am 41:531–547CrossRefGoogle Scholar
  41. Imrie M, Scott V, Stearns P, Bastrom T, Mubarak SJ (2010) Is ultrasound screening for DDH in babies born breech sufficient? J Child Orthop 4:3–8CrossRefGoogle Scholar
  42. Jacobsson B, Hagberg G (2004) Antenatal risk factors for cerebral palsy. Best Pract Res Clin Obstet Gynaecol 18:425–436CrossRefGoogle Scholar
  43. Jaramillo C, Johnson A, Singh R, Vasylyeva TL (2016) Metabolic disturbances in patients with cerebral palsy and gastrointestinal disorders. Clin Nutr ESPEN 11:e67–e69CrossRefGoogle Scholar
  44. Kannan S, Meert KL, Mooney JF, Hillman-Wiseman C, Warrier I (2002) Bleeding and coagulation changes during spinal fusion surgery: a comparison of neuromuscular and idiopathic scoliosis patients. Pediatr Crit Care Med 3:364–369CrossRefGoogle Scholar
  45. Kolaski K, Logan LR (2007) A review of the complications of intrathecal baclofen in patients with cerebral palsy. NeuroRehabilitation 22:383–395PubMedGoogle Scholar
  46. Krach LE (2001) Pharmacotherapy of spasticity: oral medications and intrathecal baclofen. J Child Neurol 16:31–36CrossRefGoogle Scholar
  47. Lipton GE, Miller F, Dabney KW, Altiok H, Bachrach SJ (1999) Factors predicting postoperative complications following spinal fusions in children with cerebral palsy. J Spinal Disord 12:197–205PubMedGoogle Scholar
  48. Madigan RR, Wallace SL (1981) Scoliosis in the institutionalized cerebral palsy population. Spine (Phila Pa 1976) 6:583–590CrossRefGoogle Scholar
  49. Maranhao MV (2005) Anesthesia and cerebral palsy. Rev Bras Anestesiol 55:680–702CrossRefGoogle Scholar
  50. Martyn JA, Richtsfeld M (2006) Succinylcholine-induced hyperkalemia in acquired pathologic states: etiologic factors and molecular mechanisms. Anesthesiology 104:158–169CrossRefGoogle Scholar
  51. Martyn JA, White DA, Gronert GA, Jaffe RS, Ward JM (1992) Up-and-down regulation of skeletal muscle acetylcholine receptors. Effects on neuromuscular blockers. Anesthesiology 76:822–843CrossRefGoogle Scholar
  52. Miller F, Girardi H, Lipton G, Ponzio R, Klaumann M, Dabney KW (1997) Reconstruction of the dysplastic spastic hip with peri-ilial pelvic and femoral osteotomy followed by immediate mobilization. J Pediatr Orthop 17:592–602CrossRefGoogle Scholar
  53. Mitchell D, Laburn HP (1985) Pathophysiology of temperature regulation. Physiologist 28:507–517PubMedGoogle Scholar
  54. Murphy N, Such-Neibar T (2003) Cerebral palsy diagnosis and management: the state of the art. Curr Probl Pediatr Adolesc Health Care 33:146–169CrossRefGoogle Scholar
  55. Murphy NA, Irwin MC, Hoff C (2002) Intrathecal baclofen therapy in children with cerebral palsy: efficacy and complications. Arch Phys Med Rehabil 83:1721–1725CrossRefGoogle Scholar
  56. Mutch L, Alberman E, Hagberg B, Kodama K, Perat MV (1992) Cerebral palsy epidemiology: where are we now and where are we going? Dev Med Child Neurol 34:547–551CrossRefGoogle Scholar
  57. Nasreddine W, Beydoun A (2008) Valproate-induced thrombocytopenia: a prospective monotherapy study. Epilepsia 49:438–445CrossRefGoogle Scholar
  58. Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC (2000) Anaesthesia and pain management in cerebral palsy. Anaesthesia 55:32–41CrossRefGoogle Scholar
  59. Oh CW, Presedo A, Dabney KW, Miller F (2007) Factors affecting femoral varus osteotomy in cerebral palsy: a long-term result over 10 years. J Pediatr Orthop B 16:23–30CrossRefGoogle Scholar
  60. Palmer L, Blair E, Petterson B, Burton P (1995) Antenatal antecedents of moderate and severe cerebral palsy. Paediatr Perinat Epidemiol 9:171–184CrossRefGoogle Scholar
  61. Pharoah PO, Cooke T, Rosenbloom L (1989) Acquired cerebral palsy. Arch Dis Child 64:1013–1016CrossRefGoogle Scholar
  62. Rose JB, Theroux MC, Katz MS (2000) The potency of succinylcholine in obese adolescents. Anesth Analg 90:576–578CrossRefGoogle Scholar
  63. Saissy JM, Vitris M, Demaziere J, Seck M, Marcoux L, Gaye M (1992) Flumazenil counteracts intrathecal baclofen-induced central nervous system depression in tetanus. Anesthesiology 76:1051–1053CrossRefGoogle Scholar
  64. Sankar PS, Pasquale LR, Grosskreutz CL (2001) Uveal effusion and secondary angle-closure glaucoma associated with topiramate use. Arch Ophthalmol 119:1210–1211PubMedGoogle Scholar
  65. Spiroglou K, Xinias I, Karatzas N, Karatza E, Arsos G, Panteliadis C (2004) Gastric emptying in children with cerebral palsy and gastroesophageal reflux. Pediatr Neurol 31:177–182CrossRefGoogle Scholar
  66. Starnes DS, Lawrence H, Navaratnam R (2016) Is constipation a trivial matter? BMJ Case Rep.  https://doi.org/10.1136/bcr-2015-213085
  67. Stiers P, Vanderkelen R, Vanneste G, Coene S, de Rammelaere M, Vandenbussche E (2002) Visual-perceptual impairment in a random sample of children with cerebral palsy. Dev Med Child Neurol 44:370–382CrossRefGoogle Scholar
  68. Theroux MC, Akins RE (2005) Surgery and anesthesia for children who have cerebral palsy. Anesthesiol Clin North America 23:733–743. ixCrossRefGoogle Scholar
  69. Theroux MC, Dicindio S (2014) Major surgical procedures in children with cerebral palsy. Anesthesiol Clin 32:63–81CrossRefGoogle Scholar
  70. Theroux MC, Brandom BW, Zagnoev M, Kettrick RG, Miller F, Ponce C (1994) Dose response of succinylcholine at the adductor pollicis of children with cerebral palsy during propofol and nitrous oxide anesthesia. Anesth Analg 79:761–765CrossRefGoogle Scholar
  71. Theroux MC, Akins RE, Barone C, Boyce B, Miller F, Dabney KW (2002) Neuromuscular junctions in cerebral palsy: presence of extrajunctional acetylcholine receptors. Anesthesiology 96:330–335CrossRefGoogle Scholar
  72. Theroux MC, Oberman KG, Lahaye J, Boyce BA, Duhadaway D, Miller F, Akins RE (2005) Dysmorphic neuromuscular junctions associated with motor ability in cerebral palsy. Muscle Nerve 32:626–632CrossRefGoogle Scholar
  73. Van Heest AE, House J, Putnam M (1993) Sensibility deficiencies in the hands of children with spastic hemiplegia. J Hand Surg [Am] 18:278–281CrossRefGoogle Scholar
  74. Vender JR, Hester S, Waller JL, Rekito A, Lee MR (2006) Identification and management of intrathecal baclofen pump complications: a comparison of pediatric and adult patients. J Neurosurg 104:9–15PubMedGoogle Scholar
  75. Warner MA, Martin JT (1997) The ventral decubitus (prone) position. In: Martin JT, Warner MA (eds) Positioning in anesthesia and surgery. WB Saunders, Philadelphia, p 155Google Scholar
  76. Wass CT, Warner ME, Worrell GA, Castagno JA, Howe M, Kerber KA, Palzkill JM, Schroeder DR, Cascino GD (2012) Effect of general anesthesia in patients with cerebral palsy at the turn of the new millennium: a population-based study evaluating perioperative outcome and brief overview of anesthetic implications of this coexisting disease. J Child Neurol 27:859–866CrossRefGoogle Scholar
  77. Weir KA, Mcmahon S, Taylor S, Chang AB (2011) Oropharyngeal aspiration and silent aspiration in children. Chest 140:589–597CrossRefGoogle Scholar
  78. Wilken B, Aslami B, Backes H (2008) Successful treatment of drooling in children with neurological disorders with botulinum toxin A or B. Neuropediatrics 39:200–204CrossRefGoogle Scholar
  79. Wongprasartsuk P, Stevens J (2002) Cerebral palsy and anaesthesia. Paediatr Anaesth 12:296–303CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Anesthesiology and Perioperative MedicineNemours/Alfred I. duPont Hospital for ChildrenWilmingtonUSA
  2. 2.Department of Pediatrics, Jefferson Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Department of Anesthesiology, Jefferson Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

Section editors and affiliations

  • Freeman Miller
    • 1
  1. 1.AI DuPont Hospital for ChildrenWilmingtonUSA

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