Reduced MAC – inhalation agent MAC is reduced.

Elevated Non-depolarizing Muscle Relaxants (NDMRs) – These patients require higher doses of NDMRs. This is due to up regulation of Ach receptors which results in a shorter duration of action for these drugs.

Succinylcholine – Succinylcholine should generally be avoided for patients with cerebral palsy . Extrajunctional acetylcholine receptors are common in these patients. This suggests the possibility of hyperkalemia. If used, these patients require a lower dose.

High aspiration risk – Take a careful airway examination. These patients often have swallowing difficulties (Consider using an antisialogogue), GI dysmotility, abnormal lower esophageal sphincter tone – all of which lead to GERD.

Thoroughly preoxygenate – Focus on good preoxygenation prior to intubation – Many suffer from recurrent aspiration and reduced pulmonary reserve.

Warm the patient – Heat loss is a major consideration in CP patients because they have thin skin, very little subcutaneous fat, and atrophic musculature. Large surface area to body weight ratios making heat preservation difficult. Actively warm these patients throughout the perioperative period.

Difficult airway risk – Airway management can be difficult due to poor dental hygeine, loose teeth, and temporomandibular joint dislocation (due to muscle spasticity).

Seizure risk – Epilepsy / Seizure disorder is common

Smaller ETT tubes – Patients are generally small for their age (be careful in your selection of equipment / techniques based on age).

Careful positioning – Non-weight-bearing long bones are underdeveloped and easier to fracture.

Blood loss risk – Muscle contracts poorly when surgically incised. This can result in significant blood loss during major surgery.

Altered mental status – Possible abnormalities in perception, cognition, and behavior.

Neurogenic bladder – seen in 30%-60% of these patients.

Speech impairment – a common problem in these patients which may lend to greater preoperative anxiety. Consider using the FLACC pain scale or something similar to assess postoperative pain.

Polypharmacy – The majority of patients will be taking a combination of multiple medications. Watch this closely as it will give a good indication of prominent morbidities in the patient.

Delayed emergence – this is a common problem. Be judicious with CNS depressing drugs.

Extubate awake – delayed emergence, GERD, compromised swalling reflexes, etc.

Central nervous system disorder resulting from insult to the centers of the brain that control movement, balance, and posture that occur when the brain is developing. Non-progressive, but symptoms may manifest differently throughout the patient’s lifetime.

This condition is believed to be caused primarily by adverse intrapartum events. The literature repeatedly cites maternal intrapartum febrility (>38 degrees celcius) as being a potential cause of cerebral palsy. Infants born to these mothers were 2-9 times more likely to have cerebral palsy.

This disease results in movement abnormalities and postural problems. Postural problems are often truncal, which leads spinal curvature abnormalities (ie scoliosis).

In the long-term truncal muscle, spasticity can lead to scoliosis, restrictive lung defects, pulmonary hypertension, and ultimately cor pulmonale and respiratory failure.

This is the most common cause of motor impairment in children – so you are very likely to see multiple CP patients in your career as an anesthesia provider.

1.5-4.0 per 1000 live births in the U.S. More common in boys and African Americans