脑性瘫痪患儿麻醉ppt课件.ppt

Anesthesia in Cerebral Palsy;《Part 1》 Case Presentation;Brief history;Present Illness;Brief History;Growth Development Body weight=12 Kg (3 percentile) DMS：Developmentally delay Gross motor：Cannot stand or jump Fine motor： Putting on clothes (-) Wearing shoes (-) Feeding with spoon (-) Verbal：Just nonsense murmuring voice ;Past History;Past History;Medication;PE findings;;Procedure;;;;;《Part 2》Discussion;Cerebral Palsy;Etiology of Cerebral Palsy;Classification for Cerebral Palsy;Pre-operative assessment;Gastrointestinal Problems;Respiratory Problems;Epilepsy;Visual deficits;Behavioral Communication Problems;Premedication;Anaesthesia in CP;Peri-operative management;Airway maintenance;Drug responses;Patients with upper motor neuron disease are resistant to NDMR.;An increase number of junctional and extrajunctional acetylcholine receptors Immobilization with muscle atrophy Concomitant administration of phenytoin and phenobarbital Drug interactions: increased metabolism of the muscle relaxant via hepatic enzyme decreased sensitivity of muscle receptors to the MR increased numbers of receptors increased muscle end-plate cholineasterase activity;;;Children with CP and severe mental retardation may require lower concentration of inhalational anaesthetics than healthy children.;Elevated pain threshold, decreased central pain perception Lower motor neuron more sensitive to inhalational anaesthetics Children with CP had significantly lower MAC values whether they took anticonvulsant drugs or not.;;Post-operative management;Emergence from anaesthesia may be delayed;Postoperative chest  Physiotherapy;Irritability on emergence from anaesthesia is common;Maintain  anticonvulsant / baclofen;Children with CP are prone to constipation;Reference: J. Nolan, G.A. Chalkiads, J. Low, C.A. Olesch and T.C.K. Brown. Anaesthesia and pain management in cerebral palsy. Anaesthesia, 2000; 55: 32-41 Moorthy SS, Krishna G, Dierdorf SF. Resistance to vecuronium in p