CEREBRAL PALSY AND ANAESTHESIA

Abstract

Cerebral palsy is the result of an injury to the developing brain during the antenatal, perinatal or postnatal period. However, there is a strong relationship between prematurity and hence low birth weight and the incidence of cerebral palsy. Also there is a strong relationship between spastic cerebral palsy and hypoxia in premature babies. Other risk factors include prenatal abnormalities, biochemical abnormalities, genetic cause, environmental toxins and postnatal events like infections or trauma. ; :··. Many classification systems have been proposed for cerebral palsy. These classifications were done according to pathology, site of brain injury, anatomy, function, severity, physiology, and aetiology. However Swedish classification is the most currently used. Clinical manifestations relate to the area affected. The most common presentation is spastic hemiplegia, in which the arm is _ affected more than the legs. Other presentations include spastic quadriplegia, spastic diplegia, extrapyramidal cerebral palsy (which is classified into choreo- athetotic and dystonic cerebral palsy), atonic cerebral palsy, ataxic cerebral palsy and mixed type which includes clinical picture of many types of cerebral palsy. Some of the conditions associated with cerebral palsy require surgical intervention. Pre-operative assessment is essential as those patients usually have many problems, which includes gastrointestinal problems like gastero-esophageal reflux and excessive salivation, respiratory disorders including pulmonary aspiration from reflux. Also, one third of these patients develops seizure disorder. Intellectual disability is common, and in these affected may range from mild to sever. These children should have special handling as communication disorders and sensory deficits may mask mild or normal intellect.