Anestesia e paralisia cerebral

Március Vinícius M Maranhão

doi:10.1590/S0034-70942005000600012

Review Article

Anestesia e paralisia cerebral

Anesthesia and cerebral palsy

Március Vinícius M Maranhão

http://dx.doi.org/10.1590/S0034-70942005000600012 Braz J Anesthesiol, vol.55, n6, p.680-702, 2005

PDF

Downloads: 1

Resumo

JUSTIFICATIVA E OBJETIVOS: A paralisia cerebral (PC) é uma doença não progressiva decorrente de lesão no sistema nervoso central, levando a um comprometimento motor do paciente. O portador de PC freqüentemente é submetido a procedimentos cirúrgicos devido a doenças usuais e situações particulares decorrentes da paralisia cerebral. Foi objetivo deste artigo revisar aspectos da paralisia cerebral de interesse para o anestesiologista, permitindo um adequado manuseio pré, intra e pós-operatório neste tipo de paciente. CONTEÚDO: O artigo aborda aspectos da paralisia cerebral como etiologia, classificação, fatores de risco, fisiopatologia, quadro clínico, diagnóstico, terapêuticas utilizadas bem como avaliação pré-operatória, medicação pré-anestésica, manuseio intra e pós-operatório, analgesia pós-operatória e dor crônica. CONCLUSÕES: O anestesiologista desempenha um papel importante na diminuição da morbidade e mortalidade anestésico-cirúrgica em pacientes portadores de paralisia cerebral. O conhecimento da fisiopatologia dos diferentes tipos de paralisia cerebral bem como das doenças associadas e suas terapêuticas é imprescindível, pois permite ao anestesiologista antecipar e prevenir complicações intra e pós-operatórias neste tipo de paciente.

Palavras-chave

ANESTESIA, DOENÇAS, Neurológica

Abstract

BACKGROUND AND OBJECTIVES: Cerebral palsy (CP) is a non-progressive disease induced by CNS injury, which leads to patients' motor impairment. CP patients are often submitted to surgical procedures due to usual diseases and some surgical situations related with CP. The aim of this article was to review cerebral palsy aspects of interest to anesthesiologists to allow an adequate pre, intra and postoperative management of these patients. CONTENTS: This article addresses cerebral palsy aspects such as etiology, classification, risk factors, pathophysiology, clinical presentation, diagnosis and therapies and, in addition to preoperative evaluation, preanesthetic medication, intra and postoperative management, postoperative analgesia and chronic pain. CONCLUSIONS: Anesthesiologists play an important role in decreasing anesthetic-surgical morbidity and mortality of cerebral palsy patients. The understanding of different aspects of cerebral palsy pathophysiologies, in addition to those of associated diseases and their therapies is paramount, because it allows anesthesiologists to anticipate and prevent intra and postoperative complications in this type of patient.

Keywords

ANESTHESIA, DISEASES, Neurological

References

Nolan J, Chalkiadis GA, Low J. Anesthesia and pain management in cerebral palsy. Anesthesia. 2000;55:32-41.

Wongprasartsuk P, Stevens J. Cerebral palsy and anesthesia. Paediatr Anaesth. 2002;12:296-303.

Kuban KC, Leviton A. Cerebral palsy. N Engl J Med. 1994;330:188-195.

Badawi N, Watson L, Petterson B. What constitutes cerebral palsy. Dev Med Child Neurol. 1998;40:520-527.

Mutch L, Alberman E, Hagberg B. Cerebral palsy epidemiology: where are we now and where are we going. Dev Med Child Neurol. 1992;34:547-551.

Nelson KB, Emery ES. 3rd - Birth asphyxia and the neonatal brain: what do we know and when do we know it. Clin Perinatol. 1993;20:327-344.

Eicher PS, Batshaw ML. Cerebral palsy. Pediatr Clin North Am. 1993;40:537-551.

Pollard RJ, Layon AJ. Latex allergy in the operating room: case report and a brief review of the literature. J Clin Anesth. 1996;8:161-167.

Meberg A, Broch H. Etiology of cerebral palsy. J Perinat Med. 2004:434-439.

Cans C, McManus V, Crowley M. Cerebral palsy of post-neonatal origin: characteristics and risk factors. Paediatr Perinat Epidemiol. 2004:214-220.

FineSmith RB, Roche K, Yellin PB. Effect of magnesium sulfate on the development of cystic periventricular leukomalacia in preterm infants. Am J Perinatol. 1997;14:303-307.

Breen TW, Yang T. The changing role of magnesium sulphate therapy. Curr Opin Anesthesiol. 1999;12:283-287.

Spinillo A, Capuzzo E, Cavalline A. Preeclampsia, preterm delivery and infant cerebral palsy. Eur J Obstet Gynecol Reprod Biol. 1998;77:151-155.

Singhi PD. Cerebral palsy-management. Indian J Pediatr. 2004;71:635-639.

Ershov VL, Ostreikov F. Complications of anesthesia and their prevention in children with spastic cerebral palsy during ambulatory surgery. Anesteziol Reanimatol. 1999;4:33-35.

Ong LC, Afifah I, Sofiah A. Parenting stress among mothers of Malaysian children with cerebral palsy: predictors of child- and parent-related stress. Ann Trop Paediatr. 1998;18:301-307.

Brett EM, Scruttom D. Cerebral Palsy, Perinatal Injury to the Spinal Cord and Brachial Plexus Birth Injury. Paediatric Neurology Textbook. 1997:291-331.

Reddihough D, Johnson H, Staples M. Use of benzhexol hydrochloride to control drooling of children with cerebral palsy. Dev Med Child Neurol. 1990;32:985-989.

Sochaniwskyj AE, Koheil RM, Bablich K. Oral motor functioning, frequency of swallowing and drooling in normal children and in children with cerebral palsy. Arch Phys Med Rehabil. 1986;67:866-874.

Salen MR, Kluwdem AJ. Anesthesia for Orthopedic Surgery. Pediatric Anesthesia. 2002:654.

Sharrock N, Beckman J D, Inda EC. Anesthesia for Orthopedic Surgery. Miller's Anesthesia. 2005:2427.

McLeud ME, Creighton RE. Central Nervous System Diseases. Anesthesia and Uncommon Pediatric Diseases. 1993;93.

Siedman L. Anesthesia for the Expremature Infant. Pediatric Anesthesia. 2002:372.

Pelegano JP, Nowysz S, Goepferd S. Temperomandibular joint contracture in spastic quadriplegia: effect on oral-motor skills. Devel Med Child Neurol. 1994;36:487-494.

Franklin DL, Luther F, Curzon ME. The prevalence of malocclusion in children with cerebral palsy. Eur J Orthod. 1996;18:637-643.

Stoelting R, Dierdorf SF. Diseases Common to the Pediatric Patient. Anesthesia and Co-Existing Disease. 1993:599.

Robinson RO. The frequency of other handicaps in children with cerebral palsy. Dev Med Child Neurol. 1973;15:305-312.

Hurley AD, Sorner R. Psychiatric aspects of cerebral palsy. Psychiatric Mental Retardation Review. 1987;6:1-5.

Ferrareto I, Souza M. Paralisia Cerebral. Ortopedia e Traumatologia: Princípios e Prática. 2003:806-807.

Edler A, Murray DJ, Forbes RB. Blood loss during posterior spinal fusion surgery in patients with neuromuscular disease; is there an increased risk. Paediatr Anaesth. 2003;13:818-822.

De Waal EE, Kalkmam CJ. Haemodynamic changes during low-pressure carbon dioxide pneumoperitoneum in young children. Paediatr Anaesth. 2003;13:18-25.

Wilson GA, Brown JL, Crabbe DG. Is epidural analgesia associated with an improved outcome following open Nissen fundoplication. Paediatr Anaesth. 2001;11:65-70.

DeLuca PA. The musculoskeletal management of children with cerebral palsy. Pediatr Clin North Am. 1996;43:1135-1150.

Anderson KJ, Farmer JP, Brown K. Reversible coma in children after improper baclofen pump insertion. Paediatr Anaesth. 2002;12:454-460.

Sacco PCN. Relaxantes Musculares de Ação Central: Alterações do Movimento. Farmacologia. 2002;368:370-371.

Gercek A, Baykan N, Dagcinar A. Does general anesthesia potentiate the GABA-ergic action of intrathecal baclofen. J Neurosurg Anesthesiol. 2004;16:323-324.

Albright AL. Intrathecal baclofen in cerebral palsy movement disorders. J Child Neurol. 1996;11(^s1):S29-S35.

Intrathecal Lioresal (baclofen)-product data sheet: Compendium of Pharmaceuticals and Specialties. 2000:847-849.

Saissy JM, Vitris M, Demaziere J. Flumazenil counteracts intrathecal baclofen-induced central nervous system depression in tetanus. Anesthesiology. 1992;76:1051-1053.

Byrnes SM, Watson GW, Hardy PA. Flumazenil: na unreliable antagonist in baclofen overdose. Anaesthesia. 1996;51:481-482.

Zuckerbraun NS, Ferson SS, Albright A. Intrathecal baclofen withdrawal: emergent recognition and management. Pediatr Emerg Care. 2004;20:759-764.

Gomar C, Carrero EJ. Delayed arousal after general anesthesia associated with baclofen. Anesthesiology. 1994;81:1306-1307.

Sill JC, Schumacher K, Southorn A. Bradycardia and hypotension associated with baclofen used during general anesthesia. Anesthesiology. 1986;64:256-258.

Belelli D, Pistis I, Peters JA. General anaesthetic action at transmitter gated inhibitory amino acid receptors. Trends Pharmacol Sci. 1999;20:496-502.

Lees G. Molecular mechanisms of anaesthesia: light at the end of channel. Br J Anaesth. 1988;81:491-493.

Albright AL. Spastic cerebral palsy: Approaches to drug treatment. Practical Therapeutics. 1995;4:17-27.

Graham HK, Aoki KR, Autti-Ramo I. Recommendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture. 2000;11:67-79.

Forssberg H, Tedroff KB. Botulinum toxin treatment in cerebral palsy: intervention with poor evaluation. Devel Med Child Neurol. 1997;39:635-640.

Fiacchino F, Grandi L, Soliveri P. Sensitivity to vecuronium after botulinum toxin administration. J Neurosurg Anesthesiol. 1997;9:149-153.

Barwood S, Baillieu C, Brereton K. Analgesic effects of botulinum toxin A: a randomized, placebo-controlled clinical trial. Dev Med Child Neurol. 2000;42:116-121.

Stoelting RK. Antiepileptic Drugs. Pharmacology and Physiology in Anesthetic Practice. 1999:506-514.

Sena EP. Drogas Antiepilepticas. Farmacologia. 2002:409.

The management of spasticity. Drug Ther Bull. 2000;38:44-46.

Redl G. Anaesthesia in handicapped children. Anaesthesia. 1998;53(^s2):78-80.

Taha S, Bartelmaos T, Kassas C. Complicated negative pressure pulmonary oedema in a child with cerebral palsy. Paediatr Anaesth. 2002;12:181-186.

Mello SS, Soares LA, Marques RS. Complicações respiratórias em anestesia geral para pacientes com paralisia cerebral: estudo prospectivo. Rev Bras Anestesiol. 2004;54(^s33).

Suzuki T, Nakamura T, Saeki S. Vecuronium-induced neuromuscular blockade in a patient with cerebral palsy and hemiplegia. Anesth Analg. 2000;91:492-493.

Moorthy SS, Krishna G, Dierdorf SF. Resistence to vecuronium in patients with cerebral palsy. Anesth Analg. 1991;73:275-277.

Hepaguslar H, Ozzeybek D, Elar Z. The effect of cerebral palsy on the action of vecuronium with or without anticonvulsants. Anesthesia. 1999;54:593-596.

Soriano SG, Martyn JA. Antiepileptic induced resistence to neuromuscular blockers: mechanisms and clinical significance. Clin Pharmacokinet. 2004;43:71-81.

Theroux MC, Brandom BW, Zagnoev M. Dose response of succinycholine at the adductor pollicis of children with cerebral palsy during propofol and nitrous oxide anesthesia. Anesth Analg. 1994;79:761-765.

Frei FJ, Haemmerle MH, Brunner R. Minimum alveolar concentration for halothane in children with cerebral palsy and severe mental retardation. Anaesthesia. 1997;52:1056-1060.

Choudhry DK, Brenn BR. Bispectral index monitoring: a comparison between normal children and children with quadriplegic cerebral palsy. Anesth Analg. 2002;95:1582-1585.

Costa VV, Duarte LTD, Saraiva RA. Regressão anestésica em pacientes com paralisia cerebral. Rev Bras Anestesiol. 1994;54(^s33).

Costa VV, Saraiva RA. Ação do óxido nitroso em crianças com paralisia cerebral: Avaliação pelo eletroencefalograma com índice bispectral e potencial evocado somatossensitivo. Rev Bras Anestesiol. 2004;54(^s33).

Iijima T, Nakamura Z, Ilvao Y. The epileptogenic properties of the volatile anesthetics sevoflurane and isoflurane in patients with epilepsy. Anesth Analg. 2000;91:989-995.

Ogasawara H, Shimodate Y, Isozaki K. Sevoflurane anesthesia for a patient with cerebral palsy. Masui. 1990;39:500-502.

Soriano SG, Logigian EL, Scott RM. Nitrous oxide depress the H-reflex in children with cerebral palsy. Anesth Analg. 1995;80:239-241.

Islander G, Vinge E. Severe neuroexcitatory symptoms after anaesthesia with focus on propofol anaesthesia. Acta Anaesthesiol Scand. 2000;44:144-149.

Kariya N, Toyoyama H, Furuichi K. Induction of general anesthesia using propofol for caesarean section of a woman with cerebral palsy. J Clin Anesth. 1999;11:672-674.

Gebhard R, Pivalizza EG, Nasri S. Bilateral intraoperative atelectasis in a child with latex allergy. Anesthesiology. 2000;93:1147-1149.

Delfico AJ, Dormans JP, Craythorne CB. Intraoperative anaphylaxis due to allergy to latex in children who have cerebral palsy: a report of six cases. Devel Med Child Neurol. 1996;39:194-197.

Puncuh F, Lampugnani E, Kokki H. Use of spinal anaesthesia in paediatric patients: a single centre experience with 1132 cases. Paediatr Anaesth. 2004;14:564-567.

Tabuchi Y, Takamitsu Y. Perioperative management for nephrectomy using combined spinal-epidural anesthesia with sedation in a patient with cerebral palsy under maintenance hemodialysis. Masui. 2002;51:1268-1271.

Volpon JB. Síndrome Compartimental. Ortopedia e Traumatologia: Princípios e Prática. 2003:1469.

Brenn BR, Brislin RP, Rose JB. Epidural analgesia in children with cerebral palsy. Can J Anaesth. 1998;45:1156-1161.

Tobias JD. A review of intrathecal and epidural analgesia after spinal surgery in children. Anesth Analg. 2004;98:956-965.

Ohta K, Katsuno M, Kawana S. Epidural opioids for post-operative pain control in pediatric patients with cerebral palsy. Masui. 1993;42:664-668.

Hesselgard K, Stromblad LG, Reinstrup P. Morphine with or without a local anaesthetic for postoperative intrathecal pain treatment after selective dorsal rhizotomy in children. Paediatr Anaesth. 2001;11:75-79.

Sparkes ML, Klein A, Duhaime AC. Use of epidural morphine for control of postoperative pain in selective dorsal rhizotomy for spasticity. Pediatr Neurosci. 1989;15:229-232.

Geiduschek JM, Haberkern CM, McLaughlin JF. Pain management for children following selective dorsal rhizotomy. Can J Anaesth. 1994;41:492-496.

Lauder GR. White MC - Neuropathic pain following multilevel surgery in children with cerebral palsy: a case series and review. Paediatr Anaesth. 2005;15:412-420.

Anestesia e paralisia cerebral

Anesthesia and cerebral palsy

Március Vinícius M Maranhão

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

Braz J Anesthesiol