Cerebral Palsy

Question 1

What is cerebral palsy?

Answer 1

Cerebral palsy is not a specific disease, but a varied set of
symptoms that occur due to lesions of the brain that occur
during early stages of development.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 604-605.

Question 2

How is cerebral palsy classified?

Answer 2

Cerebral palsy is classified according to the extremities involved
(quadriplegia, monoplegia, etc.) and the type of neurologic
dysfunction (hypotonic, spastic, athetotic, etc.).
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 604-605

Question 3

What is the most common symptom of cerebral
palsy? What other conditions may accompany
cerebral palsy?

Answer 3

Skeletal muscle spasticity is the most common symptom of
cerebral palsy. Other symptoms that may appear are seizures,
choreoathetosis, dystonia, mental retardation, cerebellar ataxia,
and speech disorders.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 604-605.

Question 4

What medications are used in the treatment of

cerebral palsy?

Answer 4

Medical treatment is often aimed at the relief of muscle
spasticity and include medicines such as dantrolene, Botox
injections, and baclofen.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605.

Question 5

What surgeries are patients with cerebral palsy likely

to undergo?

Answer 5

Children with cerebral palsy often undergo elective surgery to
correct musculoskeletal disorders. Common surgeries include
Achilles’ tendon lengthening, osteotomy of the femur, iliopsoas
release, and scoliosis correction. Gastric reflux is often severe
enough that surgery to correct it is necessary.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605

Question 6

What are the anesthetic considerations for the

patient with cerebral palsy?

Answer 6

They have an increased incidence of reflux and weak
pharyngeal and laryngeal muscles. They are susceptible to
hypothermia and require close temperature monitoring.
Tracheal extubation may need to be delayed until the patient is
fully awake and airway reflexes return. MAC is generally
decreased and emergence times are longer.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605.

Question 7

Many patients with cerebral palsy take baclofen.
Why is it so important to ensure that baclofen is
continued throughout the perioperative period

Answer 7

Abrupt discontinuation of baclofen can result in withdrawal
symptoms such as itching, confusion, hallucinations, and
seizures.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605.

Question 8

Is succinylcholine contraindicated in patients with

cerebral palsy?

Answer 8

Even though they may suffer muscle weakness and spasticity,
patients with cerebral palsy do not have an exaggerated
hyperkalemic response to succinylcholine, nor are they more
susceptible to malignant hyperthermia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605.

Question 9

How do patients with cerebral palsy respond to

nondepolarizing muscle relaxants?

Answer 9

The use of antiseizure medications is common in these patients
and they may display a subsequent resistance to
nondepolarizing muscle relaxants.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 605.