Chronic Disease of Childhood

  • Alison CarlyleEmail author
  • Soo-Im Lim


Cerebral Palsy describes a spectrum of neurological motor disorders that can be associated with other conditions such as seizures and intellectual impairment. Most children have increased muscle tone or spasticity in one or more muscle groups or limbs. There is a broad range in the severity of problems in these children, and children with more severe forms present a number of challenges for anesthesia. These include communication, positioning, hypothermia, respiratory function and pain management. Myopathies are uncommon conditions that have important implications for anesthesia. Most young children with muscle diseases undergo anesthesia without problem. There are, however, three specific risks—the risk of rhabdomyolysis from suxamethonium in any child with a myopathy; the risk of rhabdomyolysis from volatile agents in a child with muscular dystrophy, and finally the risk of malignant hyperthermia in some children with specific, rare muscle disorders. Children with mucopolysaccharidosis can be among the most difficult to anesthetize because they can have a very difficult airway, poor cardiac function, and developmental issues affecting behavior. The incidence of Type I diabetes in children is increasing. Many of these children now have insulin pumps and continuous glucose monitoring. Autism spectrum disorder is a group of disorders characterized by deficits in social interaction and communication with repetitive or unusual behaviors. Anxiety and behavior are the main issues for anesthesia, for which there are many practical and pharmacological strategies to help with their management.


Cerebral palsy, anesthesia, analgesia Anesthesia, rhabdomyolysis Malignant hyperthermia Anesthesia mucopolysaccharidosis Anesthesia, Hunter Hurler syndrome Autism spectrum disorder and anesthesia Perioperative management diabetes children 

Further Reading

Cerebral Palsy

  1. Nolan J, et al. Anaesthesia and pain management in cerebral palsy. Anaesthesia. 2000;55:32–41.CrossRefGoogle Scholar
  2. Prosser DP, Sharma N. Cerebral palsy and anaesthesia. Contin Educ Anaesth Crit Care Pain. 2010;10:72–6.CrossRefGoogle Scholar

Muscle Disorders

  1. Barnes C, et al. Safe duration of postoperative monitoring for malignant hyperthermia patients administered non-triggering anesthesia: an update. Anaesth Intensive Care. 2015;43:98–103. A survey of 206 patients showing standard postoperative monitoring times are safe and appropriate.CrossRefGoogle Scholar
  2. Brandon BW, Veyckemans F. Neuromuscular diseases in children: a practical approach. Pediatr Anesth. 2013;23:765–9. A very good review from a practical viewpoint of anesthetizing a child with a known or suspected myopathy.CrossRefGoogle Scholar
  3. Cripe LH, Tobias JD. Cardiac considerations in the operative management of the patient with Duchenne or Becker muscular dystrophy. Pediatr Anesth. 2013;23:777–84.CrossRefGoogle Scholar
  4. Gupta PK, Hopkins PM. Diagnosis and management of malignant hyperthermia. BJA Educ. 2017;17:249–54.CrossRefGoogle Scholar
  5. Hopkins PM. Anaesthesia and the sex linked dystrophies: between a rock and a hard place. Br J Anaesth. 2010;104:397–400.CrossRefGoogle Scholar
  6. Lerman J. Perioperative management of the paediatric patient with coexisting neuromuscular disease. Br J Anaesth. 2011;107(S1):i79–89. A comprehensive and well written review.CrossRefGoogle Scholar
  7. Litman R, et al. Malignant hyperthermia susceptibility and related diseases. Anesthesiology. 2018;128:159–67.CrossRefGoogle Scholar
  8. Schieren M, et al. Anaesthetic management of patients with myopathies. Eur J Anesthesiol. 2017;34:641–9.CrossRefGoogle Scholar


  1. Hack HA, Walker R, Gardiner P. Anaesthetic implications of the changing management of patients with mucopolysaccharidosis. Anaesth Intensive Care. 2016;44:660–8. Excellent review.CrossRefGoogle Scholar
  2. Walker R, et al. Anaesthesia and airway management in mucopolysaccharidosis. J Inherit Metab Dis. 2013;36:211–9.CrossRefGoogle Scholar

Sickle Cell Disease

  1. Hyder O. Surgical procedures and outcomes among children with sickle cell disease. Anesth Analg. 2013;117:1192–6.CrossRefGoogle Scholar
  2. Jemmett K, Williams A. Preoperative screening for sickle cell disease in children: a pragmatic solution in a UK district hospital. Pediatr Anesth. 2016;26:48–51.CrossRefGoogle Scholar
  3. McCavit TL. Sickle cell disease. Pediatr Rev. 2012;33:195–204. A medical review article with a good description of the pathophysiology of sickle cell disease.CrossRefGoogle Scholar


  1. Jefferies C, et al. ISPAD clinical guidelines 2018: management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes. 2018;19:227–36.CrossRefGoogle Scholar
  2. Simha V, Shah P. Perioperative glucose control in patients with diabetes undergoing elective surgery. JAMA. 2019; This short, contemporary article reviews management in adults with diabetes, but is still very useful.CrossRefGoogle Scholar
  3. Tjen C, Wilkinson K. Perioperative care of children and young people with diabetes. BJA Educ. 2016;16:124–9.CrossRefGoogle Scholar


  1. Baines D. Anaesthetic considerations for the obese child. Paediatr Resp Rev. 2011;12:144–7.CrossRefGoogle Scholar
  2. Lerman J, Becke K. Perioperative considerations for airway management and drug dosing in obese children. Curr Opin Anesthesiol. 2018;31:320–6.CrossRefGoogle Scholar


  1. Floet AMW, Scheiner C, Grossman L. Attention-deficit/hyperactivity disorder. Pediatr Rev. 2010;31:56–68. Review article aimed at pediatricians but with much interesting information for anesthetists.CrossRefGoogle Scholar
  2. Tait AR, et al. Anesthesia induction, emergence and postoperative behaviors in children with attention-deficit/hyperactivity disorders. Pediatr Anesth. 2010;20:323–9.CrossRefGoogle Scholar

Autism Spectrum Disorder

  1. Rainey L, Van der Walt JH. The anaesthetic management of autistic children. Anaesth Intensive Care. 1998;26:682–6. An overview of autism as well as practical advice about premedication. Old but still good.CrossRefGoogle Scholar
  2. Short JA, Calder AC. Anaesthesia for children with special needs, including autistic spectrum disorder. Contin Educ Anaesth Crit Care Pain. 2013;13:107–12.CrossRefGoogle Scholar
  3. Taghizadeh N, et al. Autism spectrum disorder (ASD) and its perioperative management. Pediatr Anesth. 2015;25:1076–84.CrossRefGoogle Scholar
  4. Vlassakova BG, Emmanoui DE. Perioperative considerations in children with autism spectrum disorder. Curr Opin Anesthesiol. 2016;26:359–66.CrossRefGoogle Scholar

Anorexia Nervosa

  1. Goldstein MA, et al. Eating disorders. Pediatr Rev. 2011;32:508–20.CrossRefGoogle Scholar
  2. Hirose K, et al. Perioperative management of severe anorexia nervosa. Br J Anaesth. 2014;112:246–54.CrossRefGoogle Scholar

Von Willebrand’s Disease

  1. Mensah PK, Gooding R. Surgery in patients with inherited bleeding disorders. Anesthesia. 2015;70:112–20.CrossRefGoogle Scholar
  2. Sarangi SN, Acharya SS. Bleeding disorders in congenital syndromes. Pediatrics. 2017;139:e20154360.CrossRefGoogle Scholar

Latex Allergy

  1. Wu M, et al. Current prevalence rate of latex allergy: why it remains a problem? J Occup Health. 2016;58:138–44.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Anaesthesia and Pain ManagementPerth Children’s HospitalNedlandsAustralia

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