Cerebral Palsy (CP)
Background
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A disorder of movement & posture due to a static encephalopathy
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Huge spectrum of presentation: almost asymptomatic to completely dependent
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Caused by a cerebral insult in the immature brain that occurred prenatally, perinatally, or during infancy
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The motor deficit may manifest as:
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Hypotonia
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Spasticity
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Extrapyramidal features such as choreoathetoid/dystonic movements or ataxia
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Considerations
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↓ C-spine mobility & possible difficult intubation
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Aspiration risk (GERD/↓lower esophageal sphincter tone)
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Pulmonary:
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Recurrent aspiration & pulmonary impairment
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Scoliosis & ↑ bleeding risk during scoliosis surgery
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Rule out pulmonary HTN/RV failure
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CNS:
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Developmental delay/lack of cooperation
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Seizure d/o
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Hydrocephalus
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Altered response to anesthetics:
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↓ MAC of volatiles & longer emergence
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↑ resistance to muscle relaxants
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Volatiles & succinylcholine NOT contraindicated
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Difficult IV access, monitoring, & positioning due to contractures
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Ex-premature conditions
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↑ risk of hypothermia