Case Report

Spinal Anaesthesia for Lower Limb Orthopaedic Surgery in a Child with Spastic Cerebral Palsy

Abstract

Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anaesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anaesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Perioperative analgesia is important, particularly in orthopaedic surgeries one for pain relief. Here, we have discussed the successful management of a case of spastic CP for orthopaedic lower limb surgery.

[1] Gururaj AK, Sztriha L, Bener A, Dawodu A, Eapen V. Epilepsy in children with cerebral palsy. Seizure 2003; 12:110-4.
[2] Nolan J, Chalkiadis GA, Low J, Olesch CA, Brown TC. Anaesthesia and pain management in cerebral palsy. 2000; 55(1):32-41.
[3] Theroux MC, Akins RE. Surgery and anesthesia for children who have cerebral palsy. Anesthesiol Clin North Am. 2005; 23(4):733-43
[4] Choudhry DK, Brenn BR. Bispectral index monitoring. A comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg. 2002; 95:1582-5.
[5] Lubsch L, Habersang R, Haase M, Luedtke S. Oral baclofen and clonidine for treatment of spasticity in children. J Child Neurol. 2006;21(12):1090–1092
[6] Gilron I, Jensen TS, Dickenson AH. Combination pharmacotherapy for management of chronic pain: from bench to bedside. Lancet Neurol. 2013; 12(11):1084–1095
[7] Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society; Delgado MR, Hirtz D, Aisen M, Ashwal S, Fehlings DL, McLaughlin J, et al. 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. 2010; 74(4):336–343
[8] Baguley IJ, Cameron ID, Green AM, Slewa-Younan S, Marosszeky JE, Gurka JA. Pharmacological management of dysautonomia following traumatic brain injury. Brain Inj. 2004;18(5):409–417
[9] Lavand'homme PM, Roelants F, Waterloos H, Collet V, De Kock MF. An evaluation of the postoperative antihyperalgesic and analgesic effects of intrathecal clonidine administered during elective cesarean delivery. Anesth Analg. 2008 Sep;107(3):948-55.
[10] Smith H, Elliott J. Alpha(2) receptors and agonists in pain management. Curr Opin Anaesthesiol. 2001;14(5):513–518
[11] Hauer J, Houtrow AJ; SECTION ON HOSPICE AND PALLIATIVE MEDICINE, COUNCIL ON CHILDREN WITH DISABILITIES. Pain Assessment and Treatment in Children with Significant Impairment of the Central Nervous System. Pediatrics. 2017; 139(6):e20171002.
Files
IssueVol 9 No 1 (2023): Winter QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/aacc.v9i1.11952
Keywords
Cerebral palsy spinal anaesthesia microcephaly orthopaedic surgery.

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Deshpande J, Nashine S. Spinal Anaesthesia for Lower Limb Orthopaedic Surgery in a Child with Spastic Cerebral Palsy. Arch Anesth & Crit Care. 2023;9(1):74-76.