S Sahin, A Çolak, M ?nal, C Arar, T Yand?m
anaesthetic management, cerebral palsy, cesarean section
S Sahin, A Çolak, M ?nal, C Arar, T Yand?m. Total Intravenous Anesthesia Management Of A Patient With Cerebral Palsy During Cesarean. The Internet Journal of Anesthesiology. 2007 Volume 16 Number 1.
Cerebral palsy is a nonprogressive disorder of motion and posture. The causes are multiple, but all result in damage to the central nervous system .
We described the anaesthetic management of a 34-year-old, 72 kg, 165 cm pregnant woman with cerebral palsy was scheduled for cesarean section at 35 weeks gestation. Anesthesia was induced by propofol intravenously After the umblical cord was clamped, we performed total intravenous anesthesia, intraoperative and postoperative course uneventfully.
In this case report, we presented total intravenous anesthesia management of a patient with cerebral palsy who progresed uneventful intra and postoperative period.
Cerebral Palsy (CP) is a non-progressive disorder of the motor system secondary to brain injury during early development. Associated non-motor problems are frequent and contribute significantly to the disability. Some of the conditions associated with cerebral palsy require surgical intervention. Problems during the peri-operative period may include hypothermia, nausea and vomiting and muscle spasm. Peri-operative seizure control, respiratory function and gastro-oesophageal reflux also require consideration. Intellectual disability is common and, in those affected, may range from mild to severe. Postoperative pain management and the prevention of muscle spasm is important(1).
In this study, it is aimed to present Total Intravenous Anesthesia (TIVA) management of a patient with cerebral palsy during cesarean section.
We described the anaesthetic management of a 34-year-old, 72 kg, 165 cm pregnant woman with cerebral palsy was scheduled for cesarean section at 35 weeks gestation. Cerebral palsy had been diagnosed when she was a neonate. She could walk by himself, although with difficulty. Before operation at preanesthesia, no cardiovascular, respiratory, digestive and renal systems abnormalities were detected. Hemoglobin, white cell count, platelet count , coagulation tests, plasma electrolytes, were normal. Because she could not be positioned for spinal anesthesia and general anesthesia was selected. She was monitored with peripheral oxygen saturation (SpO2), electrocardiogram (leads II, V1), cutaneous temperature (T), noninvasive blood pressure (NIBP). Heat rate: 98 min-1, blood pressure: 135/55 mmHg, body temperature 37.2 ºC. Anesthesia was induced by using 2 mg/kg propofol intravenously. During adequate anesthesia, tracheal entubation was performed without any neuromusculer blockers. After tracheal entubation, 50 % oxygen in air inhalation was started. The interval between induction and delivery was 20 minutes. After delivery 10 IU oxytocin was administered. Apgar scores were 9 and 10 at 1 and 5 minutes. After the umblical cord was clamped Total Intravenous Anesthesia maintenance was achieved by using 6 mg/kg propofol and 1 µg.kg-1.min-1 remifentanil infusion intravenous. After recovery of muscle tone, spontaneous breathing was adequate, trachea was extubated. No respiratory or hemodynamic problems were occurred. The patient was admitted to recovery room with stable vital signs (avarage blood pressure: 115/55 mmHg, heart rate 85 beats.min-1, peripheral oxygen saturation 99%, body temperature 37.2 ºC). Thirty minutes later she was sent to service with stable vital signs.
Cerebral palsy is an almost common disorder with an estimated prevalence of 2-4/1000 population. Major causes are hypoxia of brain , central nervous system infections, birth trauma and consecutive hematoma. The classical findings are spasticity, paralysis, seizures, unsteady gait, dysarthria and mental retardation. The treatment is usually symptomatic and the development of intensive care units (2). Cerebral palsy had been diagnosed when our patient was a neonate. The range of motion of the patient's limbs was severely limited because of spastic quadriplegia; however, she could walk by himself, although with difficulty.
Regional anesthesia is particularly valuable for patients with cerebral palsy but general anesthesia is sometimes required for delivery. Because our patient suffered from severe curvature of the spine, and general anesthesia was selected (1).
Gregory et al.(3) reported that propofol for induction and maintenance of anaesthesia at caesarean section a comparison with thiopentone/enflurane. There were no differences in maternal recovery times or psychomotor performance. Saricaoglu et al.(4) suggest that noncommunicative/nonverbal children with Cerebral palsy require less propofol to obtain the same BIS values (i.e. 35–45) than do otherwise healthy children. We performed total intravenous anesthesia, intraoperative and postoperative course uneventfully.
Moorthy et al. (5) concluded that Cerebral palsy patients showed resistance to vecuronium and rapid recovery from neuromuscular block, compared with non- Cerebral palsy patients.The resistance may be secondary to acetylcholine receptors (AchR) proliferation. Succinylcholine use in certain clinical conditions (e.g., burns, denervation, muscle damage, etc.), may lead to a dramatic and sometimesfatal increase in serum potassium.(6,7,8) . In the present case, during adequate anesthesia, tracheal entubation was performed without any neuromusculer blockers.
In conclusion, Total Intravenous Anesthesia can be safety used to Cerebral palsy . We think that general anaesthesia can be performed succesfully with hemodynamic stable.
Anaesth Dr. Sevtap Hekimoglu Sahin Trakya University Medical Faculty, Department of Anaesthesiology and Reanimation, 22030, Edirne, TURKEY Tel No: 0 90 284 2357641/3200 Fax No: 0 90 284 2358096 E-mail. email@example.com