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Perioperative Care of Children with Cerebral Palsy and Behavioral Problems

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Perioperative Medicine in Pediatric Anesthesia

Abstract

Cerebral palsy (CP) is a general term covering a variety of nonprogressive conditions caused by lesions or anomalies of the brain occurring early in development. The clinical presentations vary widely. Most patients with CP have significant spasticity and are at great risk of developing contractures. Coexisting epilepsy occurs in up to 30 % of patients with CP. Laparoscopic Nissen fundoplication and major orthopedic surgery, e.g., scoliosis surgery or hip reconstruction, are common interventions. Preoperatively, the particularities of the patient should be known, including all relevant medical and social aspects. The key challenges for the anesthesiologist are positioning, obtaining vascular access, maintaining thermal homeostasis, and correct drug dosing. An increased sensitivity to anesthetic agents and a resistance to non-depolarizing neuromuscular blocking agents can be expected. Intermittent nocturnal desaturation up-regulates endorphin receptors and enhances sensitivity to opioids. Postoperatively, the liberal use of regional techniques allows for prophylactic pain control. Precision and meticulous care is particularly important in these patients to optimize perioperative care and outcome.

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Authors and Affiliations

  1. Pediatric Anesthesia, Department of Anesthesia, Luzerner Kantonsspital, 6000, Luzern 16, Switzerland

    Martin Jöhr

  2. Neonatal and Pediatric Intensive Care Unit, Children’s Hospital, 6000, Luzern 16, Switzerland

    Thomas M. Berger

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  1. Martin Jöhr
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  2. Thomas M. Berger
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Correspondence to Martin Jöhr .

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Editors and Affiliations

  1. UCO di Anestesia e Rianimazione, AO-U Policlinico di Catania, Catania, Italy

    Marinella Astuto

  2. MUHC Montreal Children’s Hosp, McGill Un, Department of Anesthesia, Montreal, Canada

    Pablo M Ingelmo

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Jöhr, M., Berger, T.M. (2016). Perioperative Care of Children with Cerebral Palsy and Behavioral Problems. In: Astuto, M., Ingelmo, P. (eds) Perioperative Medicine in Pediatric Anesthesia. Anesthesia, Intensive Care and Pain in Neonates and Children. Springer, Cham. https://doi.org/10.1007/978-3-319-21960-8_17

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  • DOI: https://doi.org/10.1007/978-3-319-21960-8_17

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-21959-2

  • Online ISBN: 978-3-319-21960-8

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