Anaesthesia and pain management in cerebral palsy

Cerebral palsy is the result of an injury to the developing brain during th e antenatal, perinatal or postnatal period. Clinical manifestations relate to the area affected. Some of the conditions associated with cerebral palsy require surgical intervention. Problems during the peri-operative period m ay include hypothermia, nausea and vomiting and muscle spasm. Peri-operativ e seizure control, respiratory function and gastro-oesophageal reflux also require consideration, intellectual disability is common and, in those affe cted, may range from mild to severe. These children should be handled with sensitivity as communication disorders and sensory deficits may mask mild o r normal intellect. They should be accompanied by their carers at induction and in the recovery room as they usually know how best to communicate with them. Postoperative pain management and the prevention of muscle spasm is important and some of the drugs used in the management of spasm such as bac lofen and botulinum term are discussed. Epidural analgesia is particularly valuable when major orthopaedic procedures are performed.