Research Article
Volume 6 Issue 3 - 2020
The Choice of Anesthesia for Reconstructive Surgery in Children with Cerebral Palsy
Nasibova EM*
Azerbaijan Medical University, Baku, Azerbaijan
*Corresponding Author: Nasibova EM, Azerbaijan Medical University, Baku, Azerbaijan.
Received: January 23, 2020; Published: February 27, 2020




Abstract

Introduction: The selection of the optimal method of anesthesia for reconstructive surgery for cerebral palsy remains relevant to this day.

Aim of the Study: To optimize anesthetic management in children with cerebral palsy based on balanced intravenous anesthesia and caudal block.

Materials and Research Methods: Our work is based on research and analysis of anesthesia in 27 patients aged 3 to 11 with a diagnosis of cerebral palsy in the form of spastic diplegia of moderate and severe severity, operated routinely in the AMU surgical clinic for the period from 2014 to 2019. The main method of analgesia in children with cerebral palsy is general anesthesia using muscle relaxants, narcotic analgesics and mechanical ventilation. Caudal anesthesia during these operations is not an alternative and routine practice. Induction of anesthesia in the general anesthesia group was carried out with propofol at a rate of 3 - 4 mg/kg, and maintenance of anesthesia with an inhaled anesthetic isoflurane and narcotic analgesic fentanyl. Intubation was carried out after administration of esmeron of 0.6 mg/kg. In the group of patients with caudal blockade, induction and maintenance of anesthesia was carried out only with propofol using a Brown syringe pump. After the patient was completely asleep, the caudal block was turned over onto the left side. A mixture of local anesthetics ropivacaine 4 mg/kg and dexamethasone 0.1 mg/kg was injected into the caudal canal.

Conclusion: Patients with cerebral palsy in the form of spastic diplegia during surgery under general anesthesia are characterized by arterial hypotension, tachycardia and the difficulty of transferring from artificial lung ventilation to spontaneous breathing. General anesthesia with artificial ventilation of the lungs based on propofol and fentanyl additionally violates hemodynamics due to the cardiodepressive effect of the drugs used. General anesthesia does not provide adequate protection against surgical stress. As evidenced by an increase in glucose and cortisol by 2.5 times. In the early postoperative period, the intensity of pain in children after general anesthesia was characterized as very strong and occurred immediately after the patient was transferred to the ward.

Caudal blockade provides adequate perioperative analgesia, comfort and the absence of lower limb muscle spasticity in the early postoperative period and stable central hemodynamics throughout the perioperative period.

Keywords: Cerebral Palsy; General Anesthesia; Caudal Anesthesia

References

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Citation: Nasibova EM. “The Choice of Anesthesia for Reconstructive Surgery in Children with Cerebral Palsy”. EC Anaesthesia 6.3 (2020): 01-04.

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