Update for nurse anesthetists--part 6--Perioperative care of patients with cerebral palsy

Cerebral palsy (CP) is a group of nonprogressive, motor impairment patterns due to an insult to the developing encephalon. Clinical manifestations vary by the specific motor deformity, anatomically affected region, and location of the brain injury. Spasticity is common, resulting in skeletal muscle weakness and loss of fine motor control. Spasticity in a child undergoing skeletal maturation may precipitate joint contractures and dislocation. Long-term medical care is interventional. The therapeutic goals are to increase the person's independence and improve the caretaker's ability to provide daily care. Early medical intervention to control spasticity and prevent contractures may reduce the need for future orthopedic surgical intervention. Centrally acting, tone-reducing medications may decrease spasticity but cause central nervous system side effects. Orthopedic surgical procedures may be necessary to remedy the chronic effects of increased tone on the muscles and bones of the extremities and spine. Anesthetic care of children and adolescents with CP is increasing. Thorough preoperative assessment facilitates preparation of an intraoperative care plan. Intellectual disability may attend CP and limit the person's ability to participate in preoperative preparation. Perioperative complications include hypothermia, intravascular depletion, muscle spasm, limb contracture, and seizure control. Gastroesophageal reflux and poor respiratory function might complicate anesthetic management.